THE EFFECT OF RHYTHM AND MELODY ON LANGUAGE …

THE EFFECT OF RHYTHM AND MELODY ON LANGUAGE DEVELOPMENT

AND SENSORY ORGANIZATION IN CHILDREN WITH AUTISM

A THESIS IN

Music Education

Presented to the Faculty of the University of Missouri-Kansas City in partial fulfillment of

the requirements for the degree

MASTER OF MUSIC EDUCATION

by

SARAH M. LILLIE

B.M.E., University of Northern Colorado, 2007

Kansas City, Missouri

2012

iii

THE EFFECT OF RHYTHM AND MELODY ON LANGUAGE DEVELOPMENT

AND SENSORY ORGANIZATION IN CHILDREN WITH AUTISM

Sarah M. Lillie, Candidate for Master of Music Education

University of Kansas City-Missouri, 2012

ABSTRACT

Research in language, neurology, and music suggests that constructs of music to provide

organization, such as rhythm and melody, may facilitate language skill development and

sensory organization for children with autism. This project inquired whether rhythmic

speech or melody during free-play and intervention sessions could help increase language

production and organize sensory systems, displayed by Restricted, Repetitive

Stereotypical behaviors (RRS), for children diagnosed with autism. Statistical analysis of

the data determined that neither language skills nor RRS behaviors were significantly

influenced by rhythmic speech or rhythmic speech with melody. While statistical

analysis did not suggest an effect, observational data collected during the sessions did

suggest that auditory perception and orientation toward language might have been

positively effected by rhythm and melody. Further research is necessary to determine

how the organizing principles of rhythm and melody might affect the language

development of children with autism. Anecdotal evidence is discussed to support future

research in this field.

iv

APPROVAL PAGE

The faculty listed below, appointed by the Dean of the Conservatory of Music and Dance

have examined a thesis titled “The Effect of Rhythm and Melody on Language

Development and Sensory Organization in Children with Autism,” presented by Sarah M.

Lillie, candidate for the Master of Music Education degree, and certify that in their

opinion it is worthy of acceptance.

Supervisory Committee

Deanna Hanson-Abromeit, Ph.D., Committee Chairperson Conservatory of Music and Dance

Charles Robinson, Ph.D.

Conservatory of Music and Dance

Lindsey Williams, Ph.D Conservatory of Music and Dance

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CONTENTS

ABSTRACT ....................................................................................................................... iii

LIST OF ILLUSTRATIONS ............................................................................................ vii

LIST OF TABLES ........................................................................................................... viii

ACKNOWLEDGEMENTS ............................................................................................... ix

Chapter

1. INTRODUCTION ........................................................................................................ 1

2. REVIEW OF LITERATURE ....................................................................................... 7

Impairments in Autism ................................................................................................. 12

Elements of Music ........................................................................................................ 24

Neurological Perspectives ............................................................................................. 28

Conclusion .................................................................................................................... 38

3. METHOD ................................................................................................................... 40

Participant Characteristics ............................................................................................ 40

Sampling Procedures .................................................................................................... 41

Recruitment ................................................................................................................... 42

Measures and Covariates .............................................................................................. 43

Research Design............................................................................................................ 45

Experimental Interventions ........................................................................................... 46

4. RESULTS ................................................................................................................... 54

Participant Flow ............................................................................................................ 54

Data Analysis ................................................................................................................ 56

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Observational Data........................................................................................................ 62

5. DISCUSSION ............................................................................................................. 65

Similarities and Differences Between Current Results and Extant Research ............... 67

Interpretation of Results ................................................................................................ 69

Generalizability of Findings ......................................................................................... 73

Discussion of Implications for Future Research ........................................................... 74

Appendix

A. UMKC SSIRB APPROVAL LETTER ..................................................................... 76

B. REQUEST FOR PARTICIPATION IN A RESEARCH STUDY............................. 78

C. CONSENT FOR PARTICIPATION IN A RESEARCH STUDY ............................ 80

D. DATA COLLECTION TOOL ................................................................................... 84

E. MATCHED-SENTENCES AND MUSICAL EXAMPLES...................................... 87

F. RAW DATA ............................................................................................................... 90

REFERENCES ................................................................................................................. 96

VITA ............................................................................................................................... 106

vii

LIST OF ILLUSTRATIONS

Figure Page

1. Percent of Change Means for Pre & Post Free Play ................................................. 59

2. Mean Scores of Language and RSS Behaviors During Intervention ........................ 61

viii

LIST OF TABLES

Table Page

1. Order of Interventions By Participant, Randomized for the First Condition ............... 46

2. Participant Demographics ............................................................................................ 55

3. MANOVA Results .......................................................................................................... 56

4. Percent of Change Means with Raw Data from Pre-Intervention to Post-Intervention58

5. Mean Scores of Language and RSS Behaviors During Intervention ............................ 61

6. Raw Data and Language Percent of Change Scores of Participant E ......................... 69

7. Raw Data and Percent of Change in Participant E's Vocalization Scores .................. 70

ix

ACKNOWLEDGEMENTS

A huge thank you to my thesis advisor, Dr. Deanna Hanson-Abromeit for her

guidance and countless hours brainstorming, advocacy, discussing and editing with me. I

am very thankful for such a gifted mentor. Thank you also to my thesis committee, Dr.

Lindsey Williams and Dr. Charles Robinson for their valuable input and guidance. I am

also thankful for my husband, who has encouraged and supported me through this

project.

1

CHAPTER 1

INTRODUCTION

Children with disabilities are a significant population within public education

schools. Data from 2009 reported 5.8 million children with disabilities received services

under the Individuals with Disabilities Education Improvement Act (IDEIA) in public

schools, with over 3.4 million of these students spending 80% or more of the school day

in general education classrooms (Data Accountability Center, 2007). IDEIA (2004) law

stipulates that all students receive an appropriate education in the least restrictive

environment. Students may not be excluded from educational services due to a disability,

no matter how severe the disability may be.

Music has been a component of special education since the 1800s; presently

children with special needs are often included in general music classrooms (Adamek &

Darrow, 2010). However, many music educators feel unprepared to address the needs of

individuals with disabilities in the general music classrooms (Hourigan & Hourigan,

2009). Preservice music teachers were found to be inexperienced in working with

children with special needs, and felt uncomfortable with the students and the special

education processes and terminology (Hourigan, 2009). Exposure to, and directed field

experience with, students with special needs in the music classroom may improve

conceptions of preservice music teachers to the special education process and special

education students (Hourigan, 2009). Music educators may also feel more capable in

including individuals with disabilities in the music classroom with more education

regarding students with disabilities (Wilson & McCrary, 1996). Raising awareness of the

2

physical needs and adaptive possibilities of students with disabilities may provide more

options for the inclusion of instrumental music teachers in a band or orchestra. Music

educators may also feel more capable in including individuals with disabilities after

training and education regarding unique needs of this population (Nabb & Balcetis, 2010;

Wilson & McCrary, 1996). Music educators must be familiar with the functional needs

of children with special needs in order to provide appropriate musical learning to this

population of students. One diagnosis that is growing in prevalence in the public schools

is autism. Music educators can be better prepared to meet the needs of students with

autism by understanding the diagnosis and how music can be effective to musically

educate children with autism in the general music classroom.

Autism is a developmental disorder, where disabilities can range from mild to

severe. Autism is marked by impairments in social interaction and language, and the

occurrence of restricted repetitive and stereotyped behaviors (4th ed., text rev.; DSM–IV–

TR; American Psychiatric Association, 2000). This population of students is growing in

the public education system of the United States. In 2004, 6 million children were served

under IDEIA. This number declined to 5.8 million in the fall of 2009. However, in 2004,

165,552 children were served under IDEIA with the classification of autism, while in

2009, 333,022 children with autism were served under IDEIA (Data Accountability

Center, 2007). This demonstrates a 101% increase of students with autism in schools,

thus music educators must understand how they can address the needs of these students.

Pairing music and children with autism is not a new approach. Music therapy has

long been used as an intervention technique for individuals with autism (Reschke-

3

Hernandez, 2011). There is a growing body of research in the field of music therapy to

support using music as a tool to address the functional needs of an individual with autism

(Kaplan & Steele 2005; Wan, Demaine, Zipse, Norton & Schlaug, 2010; Whipple, 2004).

While music education focuses on teaching musical skill, music therapy uses music as a

tool to affect the mental and physical state of an individual, with an aim to change

unwanted behaviors and encourage appropriate behaviors through music stimuli (Davis &

Gfeller, 1992). One of the key diagnostic qualifiers of autism is language and

communication impairment, and research suggests that music therapy is frequently used

as an intervention for facilitating expressive and receptive language for individuals with

autism (Braithwaite & Sigafoos, 1998; Kern, Wakeford & Aldridge, 2007; Kern, Wolery

& Aldridge, 2007; Thaut, 1992). Neuroscientists have also extensively studied the

mechanics of music and language. Research suggests that while the organization of

language may not be readily perceived in the brain, rhythm and melody in music may

provide a sense of structure to facilitate perception and production (Patel, 2007). Perhaps

music can be used to intentionally address language and musical development

simultaneously.

Individuals with autism also demonstrate deficits in sensory processing. Sensory

input could be described as, “a constant stream of electrical impulses flow[ing] through

sensory receptors along the spinal cord up to the brain” (Berger, 2002, p.36). When a

sensory stimulus is present, an individual with autism may perceive the stimulus as more

or less intense compared to the perception of typically developing individuals, invoking

an inappropriate response to the stimulus. Sensory integration therapy explores ways to

4

calm the sensory system, so that sensory stimuli may not be perceived as a threat, but

instead facilitate an appropriate response to a stimuli, allowing for the information to be

encoded, decoded and used (Iarocci & McDonald, 2006). Music therapists have explored

incorporating music into sensory integration in order to facilitate a calming of the sensory

system (Thaut, 1992). Playing instruments, singing, and moving to the music may assist

in the development of cognitive and intuitive responses to sensory stimuli (Berger, 2002).

It may be that music can facilitate a sense of well-being and sensory balance.

While research grows in the realm of music therapy and autism, music education

has neglected empirical research regarding the needs of students with autism within the

music classroom. Music education researchers may utilize the research in music therapy

to address the needs of students with autism through music activity, which may facilitate

education of musical concepts for this population. In addition, the scientific community

is demonstrating a strong connection between music and language. The music educator

can improve the education of a child with autism in the general music classroom by better

understanding how music can influence these children’s language development and

sensory needs.

If music educators can combine elements of rhythm with language in the general

music class, the sense of organization around a predictable rhythm may lead to a sense of

sensory organization and better language perception. This in turn may facilitate music

learning for a student with autism. In music education, researchers have explored the

most effective ways to teach rhythm to young students. Studies suggest that multi-

sensory representations of rhythms may facilitate the acquisition of rhythmic patterns

5

(Persellin, 1992) and that often, typically developing children have higher levels of

dictation and performance of rhythmic patterns by using language to correspond to the

rhythmic pattern (Colley, 1987). For example, a young student may more readily

perform and identify 16th notes if the word “wa-ter-mel-lon” is attached to the rhythm,

rather than beat counting.

Educators who utilize the Orff-Schulwerk approach of music education also

recognize the importance of using language in music education. Language is

incorporated into the rhythmic playing of instruments, spoken ostinati, and singing in the

Orff-Schulwerk (Frazee & Kreuter, 1987). High quality poetry and nursery rhymes

native to the child’s culture are advocated for use in movement, instrument arrangements,

and speech pieces. Orff-Schulwerk teachers advocate that music “sticks with the

sensuality of the sound and organizes it to ‘make sense’” (Goodkin, 2004, p. 18). The

importance of language in music education is emphasized in the Orff-Schulwerk in that

“the speech exercise comes at the beginning of all musical practice, both rhythmic and

melodic… In speech exercises it becomes easy to teach duple and triple time, the

meaning of bar-lines and upbeats, and sudden time-signature changes” (Orff & Keetman,

1958, p.141). Carl Orff was also a proponent of rhythmic music education; “I saw in a

flash where rhythmical education really ought to begin: when a child enters school – or

earlier still, at preschool age” (Orff, 1963, p.72). This approach to music education is

designed around the marriage of rhythm and language, which could be a way for music

educators to link rhythm and language for students with autism who are included in the

general music classroom.

6

In a music education environment, the main emphasis should be providing all

students with an education in the elements of music. Music education activities informed

by a strong theoretical framework that encompasses the literature on sensory input,

music, language, autism, and neurology, may better address the musical learning and

functional needs of a student with autism in the music classroom. In addition, the music

educator may more effectively use the unique qualities of melody and rhythm in music to

facilitate language and sensory organization for these children. While the population of

students with autism grows, music educators can respond by exploring strategies in the

music classroom that have been supported by research. Teaching elements of rhythm and

melody through performance and demonstration may allow the student with autism to

better organize his or her world or more readily process and use language, thus leading to

improved functionality in language and musical development. Therefore, this study will

examine how melody and rhythm may affect the sensory needs and language

development of an individual with autism.

7

CHAPTER 2

REVIEW OF LITERATURE

A music educator is frequently required to teach every student at his or her

school, but often does not receive specific training to best address the needs of an

individual with autism. According to the Diagnostic Statistical Manual of Mental

Disorders, individuals with autism often demonstrate language and social impairments

and a presence of restricted, repetitive stereotyped behaviors (4th ed., text rev.; DSM–

IV–TR; American Psychiatric Association, 2000). Music therapy has long been used as

an intervention to address these concerns (Reschke-Hernandez, 2011); however, music

education research rarely explores how to apply music-based strategies to better meet the

needs of individuals with autism. Music activities grounded in a strong research base to

address the concerns of an individual with autism may facilitate language perception and

development and sensory organization in the music classroom. Translational research

provides a means to examine music activities that can be utilized in the music education

classroom. Therefore, the purpose of this study is to compare the effectiveness of

conversational speech, rhythm-based speech, and rhythm-based speech paired with

melody to improve sensory impairments and language deficits for children with autism.

Autism Disorder is one of the disorders classified as Pervasive Developmental

Disorders (PDD). Severe impairment of social interaction and communication skills, and

the presence of stereotyped behavior, interests and activities are the markers of Pervasive

Developmental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric

Association, 2000). Four other disorders are characterized as PDDs: Rhett’s syndrome,

8

Child Degenerative Disorder, Asperger’s Disorder and Pervasive Developmental

Disorder – Not Otherwise Specified. Autism is distinguished from other PDDs based on

gender, how the symptoms present, and the path of development (4th ed., text rev.; DSM–

IV–TR; American Psychiatric Association, 2000). Autism affects one in 110 children;

occurrence is four times more prevalent in males than in females (National Institute on

Deafness and other Communication Disorders [NIDCD], 2010). Skills and behaviors

characteristic of the disorder can vary greatly in severity on a continuum of mild to

profound (Groen, Zwiers, van der Gaag, & Buitelaar, 2008; Hourigan & Hourigan, 2009;

Tecchio et al., 2003).

Three characteristics mark autism disorder: impaired social interaction; language

and communication deficits; and restricted repetitive and stereotyped behaviors, interests

and activities (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000;

Hourigan & Hourigan, 2009). A child must demonstrate abnormal characteristics in at

least one of the three diagnostic categories before the age of three to be medically

diagnosed with autism. Social interaction impairments are observed through a child’s

lack of interest in developing friendships, limited participation in social games and play,

and a limited awareness of others. Thus, a child with autism may demonstrate a

preference for solitary play (4th ed., text rev.; DSM–IV–TR; American Psychiatric

Association, 2000).

Autism impairs language and communication skills in both verbal and nonverbal

domains. A child may demonstrate a complete absence of language, or language skills

may be delayed compared to his or her peers, particularly in the appropriate use of

9

language for social interaction, as well as the proper inflection, stress, rate, and rhythm of

speech (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000).

Restricted repetitive stereotyped (RRS) behaviors, interests and activities are

demonstrated through strict adherence to routines, preoccupation and fascination with

objects, and a demonstrated narrow range of interests. Stereotyped body movements

such as hand flapping, finger flicking, rocking, spinning or swaying of the whole body

are common (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000).

Though not a diagnostic qualifier, many individuals with autism also have sensory

impairments, such as experiencing over stimulation or under stimulation from sensory

input, or seeking sensory input to calm the sensory systems. Research suggests that

sensory dysfunction may result in RRS behaviors due to the inability to appropriately

respond to sensory stimulation (Boyd, McBee, Holtzclaw, Baranek, & Bodfish, 2009;

Boyd et al., 2010; Chen, Rodgers, & McConachie, 2009; Gabriels et al., 2008).

Providing educational services to an individual with autism is highly governed by

the federal law, Individuals with Disabilities Education Improvement Act (IDEIA)

(2004). When children with autism enter public school, special education teams will

assess and create an Individualized Educational Program (IEP). Though a child may

have a medical diagnosis of autism, special education services will only be provided if

the disorder adversely affects the child’s educational performance (Individuals with

Disabilities Education Improvement Act, 2004). IEPs include present levels of

performance strengths, needs and measurable goals for children receiving special

education services (McCord & Watts, 2006). In 1990, the original law, the Individuals

10

with Disabilities Act, stipulated that all children must be educated in the least restrictive

environment, thus children with disabilities are to be included with typically developing

peers to the maximum extent that is appropriately possible (Adamek & Darrow, 2010;

Individuals with Disabilities Education Improvement Act, 2004). Regulation of the least

restrictive environment led to the practice of mainstreaming; students with disabilities are

included with typically developing peers in specified regular classroom subjects and

provided supplementary services or aids that support their learning in this environment.

This practice creates a continuum of classroom situations for children with

exceptionalities (Adamek & Darrow, 2010).

In the late 1980s, many education reformers promoted the practice of inclusion.

Special and general education teachers would co-teach in the same classroom, educating

all children in the general classroom for the entire school day, despite exceptionalities

(Zigmond, Kloo & Volonino, 2009). Recently, the No Child Left Behind educational act

called for the standardized assessment of students with disabilities, which has led to more

schools moving toward full inclusion in the general education classroom (Zigmond et al.,

2009). An ongoing debate continues regarding inclusion; some believe students should

be fully included regardless of the severity of a disability, while others advocate for the

availability of a continuum of services to meet the needs of students who cannot

appropriately learn in the general classroom (Damer, 2001; Individual with Disabilities

Education Improvement Act, 2004; Zigmond et al., 2009).

Whether a school supports full inclusion of mainstreaming, music educators are

often called on to teach students with exceptionalities. In many schools, the amount of

11

time a child with autism is included in the general classroom depends on specific

strengths and needs of each individual child. However, children with autism may

frequently attend music class with typically developing peers despite their level of ability.

Inclusion in the music classroom may prove to be a struggle for many music educators.

Music educators are increasingly expected to teach music to children with autism while

receiving little training or experience in autism (Adamek, 2001; Hourigan & Hourigan,

2009; McCord & Watts, 2006). Without an understanding of autism, music educators

may often find that the behaviors of children with autism can interrupt the learning and

performance of other children in the music class (Hourigan & Hourigan, 2009). This

may cause music educators to resist including children with autism in the music

classroom despite the federal regulation requiring the inclusion of children to the

maximum extent possible. Music educators may improve the lives of children with

autism through appropriate teaching strategies in the music classroom (Patterson, 2003),

but the instruction must address their functional needs in order to support learning.

While music education research has often overlooked addressing the needs of

students with autism, research in music therapy could provide a better understanding to

support music education with this population. Music therapy has long been used as an

intervention technique for individuals with autism (Reschke-Hernández, 2011) and there

is a growing body of evidence suggesting that music therapy may be an effective

intervention for individuals with autism (Kaplan & Steele 2005; Wan, Demaine, Zipse,

Norton & Schlaug, 2010; Whipple, 2004). An understanding of music-based

interventions applied within the context of a music education environment may support

12

growth in sensory and language development while continuing to facilitate music

learning. Based on the findings of neurological, linguistic, sensory integration and

musical rhythm and melodic research, music activity may promote the development of

linguistic skills and sensory organization for individuals with autism.

Impairments in Autism Sensory Organization

Sensory modulation is the ability of an individual to regulate the degree,

intensity, and nature of stimulation in their sensory systems (tactile, vestibular, olfactory,

gustatory, auditory, visual) (Dunn, 2006). Sensory stimulation is processed in the central

nervous system producing an appropriate response to an incoming sensation (Dunn,

2006; Kern et al., 2008). The central nervous system of typically developing individuals

is able to modulate, respond appropriately, and habituate when stimulation to a sensory

system is present. For example, if an individual walks into bright sunlight, an appropriate

response would be squinting to shield light.

Individuals with autism often display impairments in sensory processing

compared to their typically developing peers (Ashburner, Ziviani, & Rodger, 2008; Ben-

Sasson et al., 2009; Boyd et al., 2010; Houchhauser & Engel-Yeger, 2010; Leekman,

Nieto, Libby, Wing, & Gould, 2007; Minshew & Hobson, 2008). Though sensory

dysfunction is not a diagnostic qualifier of autism, the display of RRS behaviors is one of

the three characteristics of autism. Research suggests that RRS behaviors, such as hand

flapping, spinning, and self-injurious behaviors, may be a result of sensory dysfunction,

with the severity of dysfunction in sensory processing related to the frequency of RRS

13

behaviors (Boyd et al., 2010; Chen et al., 2009; Gabriels et al., 2008). These RRS

behaviors can also encompass elements such as a focus on rituals or routines, suggesting

that these behaviors may also be an element of dysfunctional cortical processing (Chen et

al., 2009). Individuals with autism may focus on and generate RRS behaviors in order to

induce a sensory experience or to calm a hyper-aroused sensory system (Liss, Saulneir,

Fein, & Kinsbourne, 2006). By addressing the sensory needs of an individual with

autism, RRS behaviors may reduce in frequency.

Research has demonstrated patterns in sensory dysfunction in individuals with

autism. There are three profiles of sensory processing impairments demonstrated by

individuals with autism: over-responsive to stimulation, meaning that tolerance for

sensory stimulation is low; under-stimulated, in that tolerance for sensory stimulation is

high; or sensory-seeking, where individual feels under-stimulated and seeks stimulation

for a feeling of balance (Ben-Sasson et al., 2009; Chen et al., 2009; Dunn, 2006).

Research suggests children with autism might most commonly display under-

responsiveness to sensory stimulation, followed by over-responsiveness and sensory

seeking behaviors (Ben-Sasson et al., 2009). The inability to regulate these responses can

lead to a feeling of disorganization and stress for an individual with autism. For example,

Therese Jolliffe, an adult with autism, describes the effect of sensory impairments:

Reality to an autistic person is a confusing and interacting mass of events, people, places, sounds and sights. There seem to be no clear boundaries, order or meaning to anything. A large part of my life is spent just trying to work out the pattern behind everything. Set routines, times, particular routes and rituals all help to get order into an unbearably chaotic life (Joliffe, Lakesdown, & Robinson, 2001, p.50).

14

When an individual is not able to organize sensations in the world around him or her self,

a feeling of well-being will be sought before higher-level thinking and skills may

develop. Therefore, it is important to address the sensory regulation of an individual with

autism in order to more effectively address his or her needs.

The nervous systems (central, sympathetic, and parasympathetic) all may

contribute to the processing of sensory stimuli. While a growing body of research

suggests the central nervous system is important in the modulation of stimuli (Dunn,

2006), the sympathetic and parasympathetic nervous systems may also play into sensory

dysfunction compared to typically developing peers (Schaff et al., 2010; Schoen, Miller,

Brett-Green, & Nielsen, 2009). The sympathetic nervous system activates in the body

during stress (fight or flight reaction) where the parasympathetic system activates while

the body is in rest (Bard & Bard, 2002). Children with autism may show lower

sympathetic nervous system arousal at a baseline measurement, and atypical arousal

when presented with stimuli than typically developing peers (Schoen et al., 2009).

Children diagnosed with sensory modulation dysfunction may also show lower

parasympathetic activity at a baseline measurement and when presented with auditory

stimuli (Schaaf et al., 2010). Sensory dysfunction may be the result of abnormalities in

general arousal levels (Rogers & Ozonoff, 2005), or abnormal points at which sensory

stimulation is tolerated (Dunn, 2006).

Several contrasting theories have been presented to explain the cause, effect and

neurological outcomes of sensory processing impairments seen in people with autism. A

consensus has yet to be reached whether impairment is a result of either a structural or

15

functional problem in the brain. The impairment may affect the sensory and cognitive

domains, yet it is uncertain whether the impairment is within or across these domains. It

is also unclear whether the impairments are a result of abnormalities within brain activity,

the integration of the nervous system, the feedback of senses in the brain, or connectivity

within the brain (Iarocci & McDonald, 2006). While the explanation for sensory

impairments is still contested, the effect of sensory processing on the behaviors of a

person with autism has been documented through various studies.

Sensory processing dysfunction may impact many areas of the life of a child with

autism, such as his or her adaptive behaviors, anxiety, and social skills. Sensory

processing abnormalities are suggested to predict communication performance and

maladaptive behaviors (Lane, Young, Baker, & Angley, 2010). Several relationships

may also exist between sensory processing and decreased adaptive behaviors; such as a

strong inverse relationship between hypersensitivity and social skills, a strong positive

relationship between anxiety and sensory defensiveness, and an increase in sensory

dysfunction (Pfeiffer, Kinnealey, Reed, & Herzberg, 2005). Research also suggests

connection between leisure activity and sensory impairment (Hochhauser & Engel-Yeger,

2010). Children with high functioning autism and severe sensory processing impairment

may demonstrate less diversity and intensity in participation of leisure activity than

typically developing peers. Moreover, these children may participate more frequently in

solitary activities, and activities in their homes. The more severe the sensory impairment,

the less a child may enjoy activities in which he or she participates compared to typically

developing peers.

16

Sensory dysfunction may also affect the behavior and learning of an individual

with autism. Behavior problems typically seen in individuals with autism may not

originate from a behavioral standpoint, but instead may be a result of the internal

disorganization from sensory dysfunction (Kern et al., 2008). These impairments may

also affect a child’s educational experience. In her firsthand account of living with

autism, Temple Grandin (2006) suggests that when one or more senses are impaired, the

ability to learn and process information from the environment is compromised. Research

supports Grandin’s experience, suggesting that the difficulty in auditory filtering and

processing could contribute to lower academic achievement, in that students with under-

responsive and sensory-seeking behaviors are unable to process verbal instructions with

other background noise present (Ashburner, Ziviani, & Rodger, 2008). The sensory

needs of a child with autism are an important consideration in the educational process. If

a child experiences his or her “systems constantly being bombarded with sensory inputs

that seem to come into the brain with no apparent rhyme or reason – no sequence, no

temporal sense and no identifiable order” (Berger, 2002, p.42), it will be difficult for the

child to learn.

While sensory dysfunction is not a diagnostic qualifier, it may be that individuals

with autism cope with the feeling of disorganization by displaying RRS behaviors. When

an individual experiences sensory impairments, behavior, learning, social skills, language

perception and adaptive behaviors may all be affected. Interventions that address other

areas of concern for individuals with autism should also examine how sensory

impairments may be alleviated as well.

17

Language

Language, speech and communication are central to the human race. Language

can be defined as “a socially shared code or conventional system for representing

concepts through the use of arbitrary symbols and rule-governed combinations of those

symbols” (Owens, 2012, p.6). Comparatively, communication is the intentional

exchange of information, thoughts and wishes through the processes of encoding,

transmitting and decoding linguistic and non-linguistic cues (Owens, 2012). Speech is

the vocalized form in which to convey meaning to another individual (Owens, 2012).

Typically developing infants begin the process of communication through sounds like

crying and laughing to convey needs and wants, developing over the following five to

seven years, resulting in the ability to convey thoughts and ideas through speech (Allen &

Marotz, 2010).

Language deficits are one of the key defining characteristics of autism (Eigsti, de

Marchena, Schuh, & Kelley, 2011 Geurts & Embrechts, 2008; Groen et al., 2008;

Kellerman, Fan, & Gorman, 2005). Just as autism is a spectrum disorder, a spectrum of

language impairments is present across the disorder. Some children may not speak; other

children may display language skills, but struggle with using language effectively to

communicate. For example, a child may have a large vocabulary, but frequently use

repetitive or rigid language, focus conversation with others on narrow interests, unevenly

develop language, or struggle to perceive and use nonverbal communication skills

(NIDCD, 2010). Most commonly children with autism who do have language skills have

impairments in pragmatics, syntax, morphology, semantics, phonology and prosody

18

(Eigsti et al., 2011). In an analysis of studies previously conducted in language

impairments of individuals with autism, Groen et al. (2008) suggests specifics in

language skill deficits to include: delayed, but not necessarily impaired phonology;

difficulties in understanding and expressing semantics; specific syntactic deficits, sparse

expressive language and undeveloped syntactic skills; and most commonly, pragmatic

and prosodic deficits, often remaining a linguistic impairment throughout life.

A growing body of research continues to try to identify specific areas of language

impairment in individuals with autism. In examining speech, syntax, semantics,

coherence, inappropriate initiation, stereotyped language, use of context, nonverbal

communication, social relationships and interests, children with autism may demonstrate

more language deficits than typically developing peers in all areas (Geurts & Embrechts,

2008). In comparing children with autism to children with specific language impairment

(SLI) and typically developing preschoolers, a profound deficit of language skills for

children with autism compared to typically developing peers may exist, and children with

SLI and children with autism may display similar impairments (Geurts & Embrechts,

2008).

Whitehouse, Barry and Bishop (2008) compared language profiles, oromotor

skills and autism-related behaviors between children with autism and children with SLI.

Assessments measuring language and memory suggested no shared visible characteristics

for language deficits in children with autism and SLI, suggesting a difference in language

dysfunction between individuals with an SLI and autism. Yet, two or more impairments

across autism-related domains were suggested to lead to low scores in non-word

19

repetition, similar to the language profile of an individual with SLI. While the profiles

are different between an individual with SLI and individuals with autism, there may be an

underlying shared system between these two groups.

In addition to speech production, auditory perception is an important element of

language development. The process of following sounds through a sequence, such as

words in a sentence, may be impaired in an individual with autism, therefore reducing the

comprehension of conversational speech (Berger, 2002). Instead, an individual with

autism may perceive chaos from the plethora of auditory stimuli around him or her.

Research has explored why auditory perception may be impaired in autism. Suggestions

include delayed processing of speech sound in the brain within the left temporal area and

the left auditory cortex (Kasai et al., 2005), intact sound processing structures, but

impaired elements such as orientation to sound changes in speech (Ceponiene et al.,

2003; Whitehouse & Bishop, 2008) or discrimination between different sound stimuli

(Tecchio et al., 2003). Individuals with autism also may passively listen to speech,

perceiving it as strange noise rather than functional language (Boddaert et al., 2003).

Despite the reason for the impairment, when perception of language is impaired,

language skills will likely be slow to develop, and searching for mediums to promote

auditory perception is important for facilitating language, speech and communication.

Music could be one such medium in that it may be perceived and processed more readily

in the brain of an individual with autism. In a study investigating the focus of attention

toward speech, Whitehouse and Bishop (2008) suggested that the process of encoding

speech sounds is impaired in individuals with autism, perhaps due to an active aversion to

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speech sounds. The researchers measured the neural activity in the brain of individuals

with autism as they were presented with speech sounds and non-speech tones. Results

indicated that while speech sounds did produce processing levels on brain output

imaging, novel tones generally caught the attention more effectively. Thus an individual

with autism may process speech tones in the brain, but behaviorally produce greater

attention to the auditory stimulation of novel tones. Comparatively, Dawson, Meltzoff,

Osterling, Rinaldi and Brown (1998) explored orientation toward sound stimulus in

children without a disability, children with Down syndrome, and children with autism.

Compared to typically developing children and children with Down syndrome, the

children with autism struggled to orient toward the sound of their name and hand

clapping; however, they did demonstrate fewer orienting errors toward non-speech

stimuli, such as a rattle or musical toy. These studies suggest that using novel sounds,

possibly with musical characteristics, may provide more effective means for an individual

with autism to process auditory stimulation.

Researchers have sought correlations between language skills and other

developmental skills. Studies in the field of language development for children with

autism have suggested that play skills may be a predictor of language skills, and as an

intervention may cultivate language in children with autism. Correlations were found

between toy play ability and language skill growth suggesting that play skills may affect

language development (Toth, Munson, Meltzoff & Dawson, 2006). Other studies have

supported the relationship between language and play skills in children with autism (Pry,

Peterson & Bahgdadli, 2009) and researchers suggest that young children with autism can

21

be taught these play skills, possibly in turn developing language skills (Kasari, Paparella,

Freeman & Jahromi, 2008). For children with autism, it may be beneficial to use a

measurement tool that will address language development through an authentic

experience like play. The Individual Growth Development Indicator (IGDI) Early

Communication Indicator (ECI) assessment utilizes play and communication between a

child and adult to measure current levels of language development, creating an ideal

measurement tool to assess communication skills (http://www.igdi.ku.edu/).

In addition to sensory processing challenges, language deficits can affect a child’s

educational experience. Temple Grandin discusses education for a child with autism,

writing, “the different thinking patterns of individuals with autism require parents and

educators to teach from a new frame of reference, one aligned with their autism way of

thinking. Expecting children with autism to learn via the conventional curriculum and

teaching methods that ‘have always worked’ for typical children is to set everyone up for

failure from the start” (Grandin, 2008, p.25). Language impairment affects many

domains of an individual with autism’s life. While production of language is often

impaired for an individual with autism, the perception of language may also be impaired.

Speech may not be the most readily perceived form of language for an individual with

autism, and other ways of producing language should be explored. In addition to

academic skills, music learning skills may be affected by this impairment. Both sensory

impairments and language skill deficits may affect the learning outcomes, active

participation and musical learning possibilities for a student with autism in the music

classroom.

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Prosody

Prosody is an element of language and communication that utilizes cues of

duration, intensity and frequency (Boutsen, 2003), including emphasis, pitch accenting,

rhythm, and intonation (Wagner & Watson, 2010). Prosody encompasses many levels of

deep organization and grouping, functioning both internally (perception) and externally

(production) (Groen et al., 2008). Perception of prosody makes use of language systems

to organize and group speech gestures to provide meaning, where production of prosody

is the intentional choices in speech of emphasis, inflection, rhythm, and word stress in

order to convey meaning (Bousten, 2003). Though prosody is important in language use,

prosodic rhythm and intonation of speech is not a primary element, but rather a secondary

formation of speech (Pitt & Samuel, 1990). Prosody in speech is a by-product of

language, not a construct upon which it is built (Patel, 2008).

Prosody is frequently utilized in speech perception. Though our language is not

organized through prosodic production and perception, it may assist a listener in

attending to speech, in that cues of normal sentence rhythm may aid in the perceptual

process (Pitt & Samuel, 1990). A classical theoretical framework of prosody advocates

classifying languages based on prosodic elements, such as stress-timed (English),

syllabic-timed (romantic languages such as French and Italian) and mora-timed

(Japanese) (Pike, 1945). This theory is contested with both proponents and opponents to

the perception of these classifications. Nazzi, Bertoncini and Mehler (1998) explored

how infants perceive language based on prosody. Results indicated that the infants could

discriminate English from Japanese sentences, however, could not discriminate between

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English and Dutch, two languages from the same prosodic categories. This study

suggests that rhythmic information may be an important element in acquisition and

perception of speech, even at the very early stages of language development.

Though prosodic groupings can aid in speech perception, individuals with autism

may display language impairments in the both the perception and production of prosody.

Compared to typically developing peers, children with high functioning autism matched

on verbal and mental age showed a significant difference in prosodic ability,

demonstrating much lower prosody development (McCann, Peppe, Gibbon, O’Hare &

Rutherford, 2007). Children with autism may also demonstrate less appropriate phrasing,

and resonance qualities compared to typically developing peers (Shriberg, Paul,

McSweeny, Klin & Cohen, 2001). Perception and production of tasks involving stress

may be the most significantly impaired element of prosody for children with autism

(Paul, Augstyn, Klin, & Volkmar, 2005). Children with autism often struggle with this

unstructured, but important element of speech perception. Possibly, through a predictable

and temporal system, prosody may be more readily perceived for individuals with autism.

While prosody does help a listener organize thoughts and ideas through rhythmic

and melodic cues, prosody becomes a by-product of language opposed to a true

organizing principle. Individuals with autism may struggle with prosodic perception, and

may require a stronger organization. Rhythmic qualities of speech may be important in

the acquisition of speech, and if a stronger and predictable pattern could be applied to

speech, individuals with autism may be better able to organize both sensory systems and

information from language.

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Elements of Music

Music contains many elements, such as rhythm, pitch, melody, harmony, timbre,

texture and expressive qualities. Like language, music is also made of sound sequences

that are complex and meaningful, but music organizes pitch and rhythm differently than

language, though language provides specificity through semantic meaning that music

lacks (Patel, 2008). By examining two aspects of music – rhythm and melody – there

may be a framework to theorize why music may be an effective tool to address the

sensory organization and prosodic language needs of individuals with autism.

Rhythm

Rhythm is present in language and communication, and in music. The rhythm of

language and communication is prosody, which can be compared to the rhythm present in

music. Through analysis of many studies on the rhythm of language, Patel (2008)

suggests that prosody is not an organizing principle of language. Instead, it is an

outcome of communication rather than a systematic structure. Prosody is perceptually

adaptive in speech through phrases and accents, but it does not occur at regular intervals.

There are, however, similarities between the rhythm of language and music. Both

systems utilize rhythm to reinforce grouping, or perception of boundaries, where the

elements between the boundaries come together in order to form a unit that is based in

time (Wagner & Watson, 2010). Research indicates that the perception of rhythmic

grouping may share cognitive resources in both the linguistic and nonlinguistic (musical)

domains (Patel, Peretz, Tramo & Labreque, 1998) and instrumental music may reflect the

speech rhythm patterns of a composer’s native language (Patel & Daniele, 2002).

25

Though there appears to be a basis for similarities of the rhythmic elements across the

domains of language and music, this study suggests that the unique organizing principles

of the rhythm of music supports a framework for using music to develop language skills

for individuals with autism.

Predictable patterns in rhythm are common in children’s music; therefore, the

discussion on rhythm will be limited to music with predictable patterns and a temporal

structure. When a steady beat is present in a musical work, the rhythm is a construct of

the composition, providing a temporally predictable periodic structure (Patel, 2008). This

is unlike language where periodic rhythm is not the foundational structure of speech.

According to Large and Jones (1999), attention is more readily allocated when events are

tracked within a temporal system and can be predictable within an internal rhythmic

structure. Comparatively, predictability in rhythmic stress of language may contribute to

better detection of sounds within words (Pitt & Samuel, 1990). When a predictable

pattern is present, attention to language and sound detection may improve. Thus a

predictable pattern could more readily facilitate language skills. Therese Jolliffe, an adult

with autism, describes her enjoyment of Baroque music and cantering on horseback. The

rhythmic quality of music and the rocking motion of the horse both provide a steady

rhythmic element (Joliffe, et al., 2001). Musical rhythm may be able to provide this

predictable, temporal system that language lacks, offering an internal sense of

stabilization to an individual with autism by providing a temporally predictable system.

The rhythmic drive of music may facilitate an organization of the sensory systems and

lead to appropriate perception and use of language.

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Rhythmic perception may not require intense music training to accurately

perceive rhythmic elements. Both musically trained and untrained individuals are able to

perceive meter and rhythmic change in a similar way (Geiser, Ziegler, Jancke, & Meyer,

2009), indicating that rhythm may be accessible to young children not trained in music.

In fact, rhythm may provide a significant role in how music is perceived for young

children, in that young children were able to perceive rhythmic information more readily

than melodic material (Demorest & Serlin, 1997). The uniqueness of music’s

predictable, temporal rhythm may explain why individuals with autism may respond well

to music.

Melody

Similarly, melody also exists in language and communication, and music. In

communication, prosody is similar to musical language through intonation, pitch accents,

and inflection. Often, a speaker uses changes in the fundamental frequency over time to

convey meaning. Speech intonation can be used to imply related ideas in a spoken

expression, as well as conveying emphasis, attitude and emotional state (Patel et al.,

1998). Based on the prosodic processing and musical intonation perception in patients

with brain damage, Patel et al. (1998) suggests that perception of speech intonation and

melodic contour share cognitive and neural resources. Comparatively, Doherty,

Fitzsimons, Asenbauer and Staunton (1999) suggest that though they are closely related

processes, melodic contour and prosody undergo distinct processing as well. Through the

emphasis in musical intonation and melodic contour, the neural processes for linguistic

intonation may develop more readily.

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Much like the rhythm of speech, the melody of speech is perceptually adaptive,

but important in helping to organize ideas one is attempting to communicate. In

conversational speech, it is suggested that the pitch intervals and fundamental frequency

of conversation can vary across speakers and within sentences of the same speaker

(Bousten, 2003). This variance does not provide a stable framework that a listener can

utilize for organization of sound. However, melodies with stable tonality, and pitches

that occur at regular intervals, are more easily remembered than melodies that function in

an atonal framework (Boltz, 1991). Providing a stable, tonal melody to conversational

speech may assist in the comprehension and allocation of intention.

Melodies with a tonal center are common in children’s music; therefore the

discussion on melody will be limited to music with a tonal center. Research indicates

when the melody of a piece is highly organized around a single pitch, known as the tonal

center, a strong foundational reference point is provided, with all other pitches related to

the tonal center (Krumhansl & Kessler, 1982). The tonal center creates a perceptual

gravitational pull to all the other pitches within the melody. A growing body of research

suggests that other pitches are perceived in relation to the tone center in a hierarchical

fashion (Janata, Birk, Tillmann & Bharucha, 2003; Krumhansl & Kessler, 1982; Patel,

2003; Stinke, Cuddy & Holden, 1997). For example, Stinke et al., (1997) suggest that

listeners perceive the fifth and the third of a scale to be more closely related to the tonal

center than the other diatonic notes, and chromatic notes are perceived least related to the

tonic center. These relations within a musical melody create a highly organized structure,

which may facilitate a strong set of perceptual relations that can lead to even more

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cognitive processes (Patel, 2003; Patel, 2008). Individuals with autism often perceive

chaos from conversational speech, thus if the strong tonal organizational principle of

melody could be applied to speech, it could aid in auditory organization for an individual

with autism. This point of reference could aid in the perception and memory of language,

creating a possibility for better comprehension and application of the meaning in

conversations.

The loose framework of rhythm and melody in linguistics may not provide the

same sense of organization that music can offer through a steady beat and tonal center.

However, the ability of music to provide a temporally predictable and perceptually

constant grouping structure through rhythm and melody may benefit an individual with

autism. While rhythm and melody in language is adaptive and unstable, a predictable

pattern in music may support detection of sound and attention to language. The temporal

organization and gravitational pull to a tonal center may assist in the sensory organization

for an individual with autism, helping to calm sensory systems, and leading to better

perception and processing of speech and language in addition to academic and musical

learning.

Neurological Perspectives

Though many studies have examined the use of music for individuals with autism,

a possible rationale for the success of music-based interventions is rarely explored.

Neurological research in sensory systems, language, music and autism may suggest a

theoretical framework to explain why music might stimulate and aid in the development

of language skills and sensory organization. Current theories of autism support the

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notion that the disorder can be explored from a neurological perspective, in that

development process, structure, and connectivity of the brain may differ from typically

developing individuals. Two theories to be discussed are weak central coherence theory

and temporal binding.

Weak Central Coherence Theory

The theory of weak central coherence (WCC) suggests an explanation for the

processing abilities in the brain and the cognitive style of an individual with autism

(Frith, 1989). Information processing may be impaired in individuals with autism (Frith

& Happé, 1994). Typical processing of information consists of the brain sending

incoming stimuli to varying local areas of the brain. These local areas weave information

together to be processed globally throughout the brain, resulting in the ability to create

higher-level meanings. Frith and Happé term this process as “central coherence” (1994,

p.121).

The weak central coherence theory asserts that individuals with autism are

deficient in central coherence, demonstrating impairment in global processing, and

instead succeed more readily in tasks that only require processing in local areas of the

brain. WCC occurs in autism when, “the ability to integrate information across a variety

of contexts (perception, attention, linguistic, semantic) for higher-level meaning is

impaired” (Iarocci & McDonald, 2006, p.80). When an individual with autism receives

information, WCC suggests that instead of being able to make a representation of the

whole picture that would lead to a higher-level cognitive process, the small, and often

unimportant, details of the information become the focus (Frith & Happé, 1994). WCC

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theory may also explain the deficit of sensory processing, in that neural networks are not

able to communicate across the brain in order to provide an appropriate response to

sensory stimuli. A consensus has yet to be reached on the validity of WCC and various

studies have presented contrasting findings to support other theories in how the brain of

an individual with autism may perceive and process information.

Enhanced Perceptual Functioning proposes an alternate theory, suggesting that

perceptual operations explain general processing abilities. The Enhanced Perceptual

Functioning theory suggests that individuals with autism display superior performance in

perceptual abilities in one sensory stimulus (typically auditory or visual). This theory

supports locally oriented functioning like WCC, but argues neural-networks are

overspecialized, enhancing perceptual processing in localized networks through tasks like

pitch and semantic recognition (Järvinen-Pasley, Wallace, Ramus, Happé, & Heaton,

2008). This suggests a greater freedom of discrimination between higher-level functions,

contrasting WCC’s claim that high-level functions are impaired (Mottron, Dawson,

Souliéres, Hubert & Burack, 2006).

Contrasting theories suggest differences in the impairment or enhancement of

local or global processing. WCC theory assumes impaired global processing and normal

local processing. Other researchers speculate that local processing may be enhanced, but

global processing is not impaired (Iarocci & McDonald, 2006; Kellerman et al., 2005),

where different studies report normal local and global processing abilities in individuals

with high functioning autism (Mottron, Burack, Iarocci, Belleville, & Enns, 2003). WCC

may also be present in some individuals with autism, but it may not be a universal

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impairment across the disorder (Lopez, Leekam, & Arts, 2008). While there is not an

agreement regarding WCC, a growing body of research supports it in auditory (Foxton et

al. 2003) and visual tasks (Happé, 1999), through the theory of underconnectivity

between brain areas in the brains of individuals with autism (Just, Cherkassky, Keller,

Kana & Minshew, 2007) and through temporal binding.

Temporal Binding

The theory of temporal binding provides a neural framework to explain the WCC

theory. Temporal binding in typically developing individuals may be responsible for “the

flexible integration of information, allowing the perception and representation of novel

object and environment” (Brock, Brown, Boucher, & Rippon, 2002, p. 214). In

comparison, “combination coding” represents the integration of well-learned information

(Brock, Brown, Boucher, & Rippon, 2002, p. 214). Individuals with autism may have a

deficit in temporal binding, and rely heavily on combination coding, resulting in

difficulty integrating novel information. Thus, while processing within local networks

may be intact, (explaining proposed standard local processing abilities) the impairment in

temporal binding may exist between local networks, resolving the proposed impairment

in global processing of the WCC theory (Brock et al., 2002; Rippon, Brock, Brown &

Boucher, 2007).

The temporal binding deficit in autism may be understood through brain activity.

The gamma frequency band is a measurement of brain activity, appearing at the

occurrence of higher-level processing, recorded through the use of an

electroencephalography (EEG). The gamma frequency band has been observed in

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response to visual perception of illusionary shapes (Tallon-Buandry, Bertrand, Delpeuch,

& Pernier, 1996). The gamma band may also create representation of objects that

originate from sensory input (Tallon-Buandry & Bertrand, 1999). The temporal binding

deficit theory hypothesizes that one of the causes of the deficit is due to abnormal gamma

activation in individuals with autism (Brock et al., 2002). Preliminary studies using

EEGs have reported abnormalities of sensory stimulated gamma activity in the brain of

an individual with autism in visual perception (Grice et al., 2001). Research also

suggests that gamma band activity plays a role in auditory functions as well. Gamma

band activity may result from auditory stimuli and be variable within time. Through this

variability, the gamma band may reflect expectancies for pulse and meter, and able to be

synchronize with outside stimuli (Zanto, Synder, & Large, 2006).

Drawing conclusions from these research projects, the use of rhythm could

manipulate the frequency of gamma band activity, and assist in increased gamma band

activity in the brains of individuals with autism. This might allow neural networks to

communicate across domains (which according to the WCC theory, is impaired), and

bring about more high-level cognitive processes, resulting in a less severe temporal

binding deficit. As musical rhythm is presented to an individual with autism, the gamma

band may synchronize to the outside, predictable stimuli, leading to sensory organization

and in turn facilitate language skills. The proposed hypothesis is based on many theories

that do not yet have a strong consensus; much more research is required to thoroughly

explore this idea.

33

The Brain, Language and Music Connection

Research indicates a neurological reasoning for language impairments in autism.

Certain brain areas in an individual with autism may follow a different developmental

process than those of typically developing individuals (Groen et al., 2008). This may be

due to structural abnormalities in the language systems of the brains of individuals with

autism (Alexander et al., 2007; Bigler et al., 2007; Groen et al., 2008; Jou, Minshew,

Keshavan, Vitale, & Hardan, 2010). In typically developing individuals, the cerebellum

(located in the back portion of the brain) contains more than 10% of the brain’s total

volume, and more than 50% of neurons in the entire nervous system and is responsible

for maintaining equilibrium, muscle tone and the coordination of muscle movement

(Bard & Bard, 2002). Recent studies have also suggested the cerebellum may be

responsible for language processing (Booth, Wood, Lu, Houk & Bitan, 2007). For

individuals with autism, functional magnetic resonance imaging has suggested an

abnormality in the structure of the cerebellum as a factor for language impairments in

autism (Allen, Müeller & Corchesne, 2004). Changes in brain structure create

differences in the function of these structures. Understanding changes in brain structure

and function may further support a rationale for the use of music to enhance language

development for children with autism. Of note for individuals with autism and in

consideration of music processing, are the brain’s gray matter, hemispheric functions, the

corpus callosum, and superior temporal gyrus.

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The brain’s gray matter, also known as the cerebral cortex and located at the front

of the brain, contains over 50 billion nerve cell bodies, with ridge-like bulges called gyri,

and small grooves called sulci and fissures. The gray matter is where memory, creative

thought, and intelligence are based (Bard & Bard, 2002). Brains of professional

musicians are reported to have increased density of gray matter in regions of the frontal

cortex (Patel, 2008). Gray and white matter is also reported to increase in the brain of a

child with autism during the second to third year of life (Groen et al., 2008). Since the

brain makeup of both individuals with autism and professional musicians is densely

packed with nerve cell bodies, this may provide some clues as to the responsiveness to

music by individuals with autism reported in music therapy literature (Reschke-

Hernandez, 2011; Whipple, 2004; Kaplan & Steele 2005; Wan, et al., 2010).

Hemispheric findings.

The brain is divided into the right and left hemispheres, and neurologists have

suggested that these sides process different categories of information. Investigations

reveal that individuals with autism may demonstrate a reversed hemispheric dominance

in language processing, in that language processing for an individual with autism might

reside in the right hemisphere, unlike typically developing individuals whose brains

process language in the left hemisphere (Boddaert et al., 2003; de Fossé et al., 2004;

Groen et al., 2008; Müller et al., 1999; Zatorre, 2005). In typically developing

individuals, Wernicke’s areas is associated with speech processing, where Broca’s areas

is typically associated with the production of speech (Bard & Bard, 2002). The brain of

an individual with autism may also function differently, such as a greater reliance on

35

Wernicke’s area than Broca’s area compared to typically developing individuals in

sentence comprehension. This suggests that individuals with autism focus more on

individual words within a sentence compared to the meaning of the whole sentence (Just,

Cherkassky, Keller, & Minshew 2004). Such findings continue to support the notion of

deficient integration across language processing systems in the brain.

While language processes, such as phoneme perception and mapping, and speech

sound processing, activate areas of the left hemisphere, musical elements, such as pitch

and melodic contour, activate the right hemisphere (Patel, 2008). Investigations also

indicate that rhythmic processing takes place in the right hemisphere (Thaut, 2003).

Studies on individuals with brain lesions support these notions, such as Peretz (1990), in

which data indicated the left hemisphere perceives local features of melody such as

specific pitches, while the right hemisphere works to represent global aspects of a melody

such as melodic contour and pitch relationships. Other studies also indicate that

processing of melodic material is strongly influenced by the right hemisphere of the brain

(Dennis & Hopyan, 2001; Peretz, Gagnon, Hébert, & Macoir, 2004). Therefore, if music

is primarily processed in the right hemisphere and it is believed that children with autism

also process language in the right hemisphere, music-based stimulation may be effective

in activating language processing in children with autism.

The corpus callosum.

The corpus callosum is made up of nerve fibers and functions as a bridge to

connect processing between the left and right hemisphere of the brain. A stronger

connection in the corpus callosum can aid in bilateral processing, where the two

36

hemispheres of the brain share information (Bard & Bard, 2002). Neurological findings

regarding the corpus callosum indicate a connection between music and autism.

Research has explored processing between both hemispheres of the brain, termed

bilateral activation, in the brains of musicians. When right-handed musicians and right-

handed non-musicians were given visual stimuli in the right and left visual fields, EEG

data suggested that musicians displayed more bilateral neural connectivity than non-

musicians. The non-musicians demonstrated asymmetry between the right and left brain,

suggesting that non-musicians may not process information across the areas of the brain

as readily as musicians might (Patston, Kirk, Rolfe, Corballis & Tippett, 2007). More

recently, Ono et al. (2011) explored how tasks involving pitch, chord structure, timbre

and rhythm might affect hemispheric laterality in musicians and non-musicians. Through

measures of brain activity, data suggested that musicians showed symmetrical amplitudes

in all musical tasks in both hemispheres while non-musicians displayed right-hemispheric

dominance.

It has also been reported that the size of the corpus callosum of male professional

musicians might be larger than those of male non-musicians (Lee, Chen, & Schlaug,

2003), while the size of the corpus callosum in individuals with autism has been shown to

have smaller total volume (Alexander et al., 2007). This smaller volume may inhibit the

ability to share information across the two hemispheres. However, the corpus callosum

size of young children might increase due to musical training (Schlaug et al., 2009).

Considering the previous research, musical training may stimulate the corpus callosum in

young children with autism, leading to an ability to engage the corpus callosum to

37

facilitate processing across both hemispheres of the brain, which may otherwise be

absent.

Superior temporal gyrus.

Individuals with normal brain function utilize the left superior temporal gyrus

(STG) for language, while the right STG controls social perception. The brains of

individuals with autism may show abnormalities in the STG (Bigler et al., 2007; Jou et

al., 2010). Differing opinions from the result of studies question the abnormalities of the

STG. In Bigler et al. (2007) MRI images comparing individuals with autism and

typically developing individuals indicated no volumetric differences in the STG.

Conversely, other MRI images have indicated statistically significant enlargement of the

STG in the participants with autism after controlling for age and total brain volume.

Post-hoc results also indicated a reduction in the right posterior STG (Jou et al., 2010).

From a musical standpoint, the STG processes melody. In an examination of

individuals who have undergone surgical excisions in the STG for relief from seizures,

Liégeois-Chauvel, Peretz, Babaï, Laguitton, & Chauvel (1998), indicated that damage to

the right STG results in a total processing disruption to melody. However, if the left STG

is compromised while the right side remains intact, melody may still be processed

efficiently. If the STG in individuals with autism is indeed enlarged on the right side

(Jou et al., 2010), where music is processed, an individual can perceive melody more

readily than language.

These neurological findings support a strong framework to use music as an

intervention for individuals with autism. Research in the neurological foundations of

38

music tend to point toward music’s ability to stimulate or activate areas of the brain often

found to be abnormal in individuals with autism. Research also suggests shared cognitive

processes exist between language and music. Many of these cognitive processes may be

deficient in the brain of an individual with autism, and music might provide a different

approach to stimulating these processes, which might in turn stimulate language

development centers. Further neurological research in music, autism and language

should be geared to address these hypotheses.

Conclusion

In conclusion, a strong theoretical framework exists to utilize music as an

intervention for individuals with autism. Findings in the organizational principles of

music rhythm and melody suggest a stronger concrete organizational structure that is not

perceptually or temporally adaptive, compared to that of language. This may facilitate a

better response to language presented musically compared to speech. Neurological

research suggests that music may relate or stimulate areas of the brain that are abnormal

in individuals with autism, especially in the areas of connectivity across the brain and

language development centers. While these conclusions from a large body of research

can be suggested, additional research in neurology and music interventions should be

conducted to explore these areas further.

Music educators must respond to these possibilities that exist between music,

brain development, autism and language. Music educators may help individuals with

autism succeed in the music classroom through the use of rhythm and music. When an

individual with autism enters the music classroom, many elements of the child’s needs

39

must be addressed, particularly in the areas of sensory organization and language

perception and speech production. It is the music educator’s job to address these needs in

order to provide the best and most appropriate musical instruction for the child.

Fortunately, as revealed through the strong theoretical foundation of previous

neurological, linguistic, musical, and autism research, elements of music may be able to

address these needs of a child with autism. However, the music educator must be willing

to explore ways to specifically target rhythm and melody for the students with autism in

the general music classroom. When sensory organization and language development is

targeted through music, musical learning may more readily take place. This study will

further explore how music may facilitate learning experiences to address the needs of

children with autism, and make practical suggestions for music educators to use in the

general music classroom.

Based on the examination of research in autism, language, music, and neurology,

this study will address the following research questions:

1) Does rhythm-based speech enhance sensory organization more effectively than

conversational speech for children with autism spectrum disorders?

2) Does rhythm-based speech plus melody enhance sensory organization more

effectively than conversational speech and rhythm alone?

3) Does rhythm-based speech enhance language production more effectively than

conversational speech for children with autism spectrum disorders?

4) Does rhythm-based speech plus melody enhance language production more

effectively than conversational speech and rhythm alone?

40

CHAPTER 3

METHOD

This study used a counterbalanced measures design randomized for the first

condition to address the following research questions:

1) Does rhythm-based speech enhance sensory organization more effectively than

conversational speech for children with autism spectrum disorders?

2) Does rhythm-based speech plus melody enhance sensory organization more

effectively than conversational speech and rhythm alone?

3) Does rhythm-based speech enhance language production more effectively than

conversational speech for children with autism spectrum disorders?

4) Does rhythm-based speech plus melody enhance language production more

effectively than conversational speech and rhythm alone?

Participant Characteristics

Participants were a convenience sample (N = 5) of male children aged five to nine

with an educational diagnosis of Autism Spectrum Disorder. Participants were recruited

from those being taught by the researcher prior to the study, and were in a specialized

instructional program for autism at a large suburban public elementary school. The

school receives federal funds through the Title I program due to the high population of

students that receive free or reduced lunch. The school has 468 students enrolled,

including 43 students who receive special education services, and 17 students who are in

the specialized instructional program.

41

In addition to the educational diagnosis of autism, eligible participants received

special education services documented on an Individual Education Plan (IEP) and spent

at least 20% of the school day in a specialized program as indicated on the IEP. Eligible

students also attended music class with typically developing peers for 45 minutes once a

week. Prior to the study, these students attended a weekly 20-minute specialized music

instruction class designed to address academic, language and social goals, and to provide

sensory organization. Eligible students demonstrated below average language abilities

for their age. Permission was given by the building principal and the district Director of

Elementary Education to conduct the study in the school. Subsequent review was

conducted by the University of Missouri-Kansas City Social Sciences Internal Review

Board, which granted approval.

Sampling Procedures

The researcher contacted the special education teachers and speech language

pathologist (SLP) at the elementary school to determine which students met eligibility for

the study. The teachers and SLP provided the student-researcher with a list of names of

students in the program who meet eligibility. Five students were identified by the school

administration as appropriate for recruitment. All eligible participants were male.

Following approval from the University of Missouri – Kansas City’s SSIRB (see

Appendix A) the researcher contacted all five families with a letter sent home to request

participation in the research study, followed by a telephone call to discuss the informed

consent. All five families granted permission for their children to participate in the study.

42

Recruitment

After receiving approval from the SSIRB (see Appendix A) a letter briefly

introducing the study was sent home with the child to the parent(s) of each eligible child,

notifying the parent of the study and eligibility (see Appendix B). Two days after

sending the letter, the parent of an eligible child was contacted by telephone to arrange a

time to meet privately with the researcher at the school to discuss the study. Protocol

determined if the parent(s) stated "no" they would not like for their child to participate,

then the researcher thanked them for their time and consideration. If the parent(s)

expressed interest in the meeting, the researcher arranged a time to present the informed

consent.

At the meeting time, an invitation was extended for the child to participate in the

study and the parent was given the opportunity to sign the informed consent or decline

the invitation to participate. It was communicated that the child’s opportunity to

participate in regularly scheduled classroom and specialized music classes would not be

affected if a parent chose not give permission for the child to participate in the study.

Students were enrolled in the study after obtaining informed consent from the student’s

parent(s). All parents expressed an interest to discuss the informed consent in a

telephone call. The informed consent was sent home for the scheduled telephone

meeting. During the phone meeting, the research project and letter of informed consent

(see Appendix C) were presented to the parent(s). The researcher read the consent form

with the parent(s) and stopped after each section to check for understanding and give the

opportunity for the parent(s) to ask questions. When the informed consent document was

43

fully read with the parent, the researcher asked if the parent had any other questions.

Once questions were clarified or if there were no additional questions, the researcher

asked, "Will you allow your child to participate in this study?" If the parent(s) stated,

"yes," the parent was asked to sign the informed consent document, send it back to school

with his or her child, and was given a copy for their records. If the parent stated that he

or she was unsure or would like to think about it, the researcher sent home a self-

addressed stamped envelope and asked them to mail the consent if they decide to

participate. If the parent(s) declined to have the child participate, the researcher thanked

them for their time and consideration. If at any time during this meeting the parent(s)

stated that they were not interested, the parent(s) were thanked for their time and the

meeting ended. All parents contacted agreed to participation in the research study.

Measures and Covariates

The study measured a demonstration of sensory organization and language

production pre-, during and post intervention for three conditions (conversational speech,

rhythmic speech, and rhythmic speech plus melody). The dependent variable measures

for sensory organization were frequency of unrelated vocal noises and restricted

repetitive stereotyped (RRS) behavior. For this study, RRS behavior was defined as

inappropriate hand movement, head motion, or body movements. Inappropriate hand

movements were operationally defined as flapping, waving, clasping or squeezing the

hands. Inappropriate head motion was defined as rolling, shaking or nodding the head.

Inappropriate body movement was operationally defined as rocking, spinning, jumping,

or leaving the area of intervention.

44

The dependent variable measures for language were frequency of gestures,

vocalizations, single word utterances and multiple word utterances. For this study,

gestures, vocalizations, single word utterances and multiple word utterances were defined

by the assessment for communication skills definitions from the Early Communication

Indicator (ECI) of the Individual Growth and Development Indicators (IGDI)

(http://www.igdi.ku.edu/). Gestures were defined as physical movements made by a

child in an attempt to communicate. Vocalizations were defined as non-word verbal

utterances, occurring alone or with gestures. Single word utterances were individual

words voiced by the child that are recognized and understood by the person hearing them.

Multiple word utterances were two or more different words voiced by the child that are

understood by the person hearing them.

The sensory and language data were recorded during the study protocol using

naturalistic observation. Volunteers recruited from the special education aides and special

education teachers at the school were baseline and intervention data collectors. All data

collectors were familiar with the participants. Those scoring the data (N = 2) were

trained in the terminology for measuring sensory organization and pre-linguistic skills

and achieved reliability, greater than or equal to .8. Linguistic and behavioral data were

gathered during protocol implementation by recording frequency of unrelated vocal

noises and RRS behavior for sensory organization using event recording (see Appendix

D).

The free-play pre- and post-test was modified from the Individual Growth

Development Indicator (IDGI) Early Communication Indicator (ECI) assessment

45

(http://www.idgi.ku.edu). The ECI assessment is conducted using a toy barn, where the

child plays alongside an adult and communication skills are observed. Research indicates

that toy play ability may be associated with future and current language skills for

individuals with Autism Spectrum Disorders (Kasari, et al., 2008; Pry, Peterson, &

Bahgdadlim, 2009; Toth, Munson, Meltzoff & Dawson, 2006). This assessment is

designed to measure gestures, vocalizations, single-word utterances and multiple-word

utterances. The IGDI and ECI have had limited use as data collection tools for children

with autism and the researcher observed concerns for reliability without video recording.

Permission to video record was not granted by the school district and was therefore not

used for this study. As a result, the IGDI and ECI assessment data collection tools were

not used as written for the study and only the response definitions of pre-linguistic

language skills were utilized. The researcher developed a data collection tool to

accommodate event recording of RSS and linguistic behavior data within the context of

naturalistic observations (see Appendix D).

Research Design

Each participant served as his own control in a counterbalanced design

randomized for the first condition as seen in Table 1.

46

Table 1

Order of Interventions By Participant, Randomized for the First Condition

Subjects Conversational

Speech Rhythmic

speech

Rhythmic speech plus

melody A 1 2 3 B 2 3 1 C 3 1 2 D 2 1 3 E 1 3 2

The participants were assigned the order of the interventions based upon the order of his

enrollment in the study. Every intervention occurred with a single participant, the

researcher, and two data collectors (who did not interact with the child). Each participant

experienced the intervention in one condition three times over the course of one week,

followed by three times in the other two conditions in subsequent weeks. Each protocol

lasted eight minutes with pre-assessment, intervention, and post-assessment where

behavioral and language data were observed and recorded using naturalistic observation.

Outcomes from each participant were clustered by condition type for statistical analysis.

Experimental Interventions

Intervention Theory

A foundational theoretical framework may support the use of music as an

effective intervention for children with autism. Rhythm and melody may be an avenue to

facilitate sensory organization through the organization and temporal sense of music.

Research suggests that children with autism may experience a feeling of chaos from

sensory stimuli, affecting the educational experience for a child with autism (Grandin,

47

2006; Joliffe, et al., 2001; Lane, et al., 2010; Pfeiffer, Kinnealey, et al., 2005). If music

can facilitate a sense of order for the child, it may provide a more ready state for learning

(Kern et al., 2008). Linguistic organization through prosody can be perceptually

adaptive, where the same sentence often varies across individual speakers (Bousten,

2003). Musical organization through rhythmic and tonal elements can be the constant

across multiple presentations of the same song (Boltz, 1991; Janata, et al., 2003;

Krumhansl & Kessler, 1982; Patel, 2003; Steinke, et al., 1997). This unique sense of

organization of music through tonal and rhythmic foundations may assist in the

perception of language for a child with autism.

The suggestion of using music to facilitate sensory organization and language

development is not solely based on previous behavioral studies. Neurological research in

linguistics, music, and autism may provide a strong theoretical framework for the

effective use of music to address these needs. The structure, developmental process, and

functioning of the brain for a child with autism may differ compared to typically

developing individuals (Alexander et al., 2007; Bigler et al., 2007; Groen et al., 2008;

Jou, et al., 2010). Also, language processing may function differently in the brain of an

individual with autism compared to the brain of a typically developing individual

(Berger, 2002; Boddaert et al., 2003; Ceponiene et al., 2003; Kasai et al., 2005; Tecchio

et al., 2003; Whitehouse & Bishop, 2008). These differences suggest the brain of an

individual with autism may perceive and process music more readily due to physical

properties of the brain and the avenues through which sensory stimuli, specifically

auditory stimuli, are processed. Therefore, two independent variables were present in

48

this study: rhythm-based speech and rhythm-based speech with melody. The control

condition was conversational speech.

Intervention Content

Matched-difficulty and tailored word combinations were composed and delivered

in three conditions: conversational speech, rhythm-based speech, and rhythm-based

speech plus melody (see Appendix E). The music used in the interventions was

originally composed and aimed to reflect the natural prosody of speech. The researcher

recorded three individuals reading the sentences for rhythmic-speech and rhythmic-

speech plus melody, notating natural inflections, intonation and rhythm of the speech.

The researcher then composed a rhythm or rhythm and melody for each sentence. The

inflection and rhythm of the speech reflected the melodic line and rhythmic meter and

beat of the music. Due to the purpose of increasing language skills, by intentionally

matching musical elements to natural qualities of speech, generalization of the music to

language may more readily occur.

The study was conducted in the school’s music classroom during each student’s

regularly scheduled daily sensory break in the specialized instruction classroom. One

goal of the study was to promote sensory organization. At this elementary school,

sensory breaks are built into these students’ schedule every day after lunch. Instead of

participating in the 10-minute sensory break with the rest of the class, the participant

received his sensory break with the researcher. Typically, the students participate in

sensory organization methods to organize senses, such as a yoga DVD or a music-based

activity from the specialized music class led by the special education teachers. The

49

participants did not participate in the typical sensory break, but went to the music

classroom and participated in the research protocol for three days a week across three

weeks. Parents received notification through the informed consent that protocol minutes

would not be accounted for in the IEP as requested by the district elementary education

director.

Prior to the beginning of the study, eligible participants attended a weekly

specialized music class with the researcher in addition to attending general music with

typically developing peers, where the researcher was the music instructor. The researcher

had offered this class for the previous four school years. In this class, students interacted

in small groups with the researcher to develop language, sensory and social skills through

music.

The protocol lasted eight minutes, with most of the time in the music room of the

school. The room was located away from other classrooms at the end of a main hallway

of the school. The classroom’s door was closed in order to reduce ambient noise and

distractions from others in the building. The room was set up with the Fisher-Price Little

People Animal Sounds Barn® on the floor in the middle of the room and the participant

and student researcher sat on the floor during the protocol. Two chairs were set up away

from, but visible to, the barn. In the chairs, two data collectors were present to record the

frequency of restricted, repetitive, stereotyped (RSS) behaviors and language output.

One data collector recorded RRS behaviors of inappropriate hand, head and body

movements and unrelated vocal noises. The other data collector recorded gestures,

vocalizations, single-word utterances and multiple-word utterances. Each data collector

50

was employed at the school in the specialized instruction program and therefore familiar

with the participants.

The protocol began when the researcher went to the participant’s classroom and

asked that the child come with her to play with the barn. The participant followed the

researcher to the music classroom. The transition from the classroom to the music

classroom was estimated to take one minute and was a familiar routine to the participants.

On the way to the classroom, the researcher asked the student about his day or weekend.

Upon entering the room, each child participated in a baseline play-based assessment of

language skills and sensory organization behaviors for two minutes. The researcher

facilitated the transition into the play-based assessment period when she gave the student

a picture icon from the picture exchange communication system that said “My Turn” and

told the student “It’s your turn.” The participant was directed to the toy barn, instructed

to sit by the barn toy, and was provided prompts to play freely with the animals. Prompt

phrases included: “It’s [participant’s name] turn to play,” “What does the cow (sheep,

horse, etc) do?” or “Show me the sheep (horse, cow, etc.).”

After two minutes of free play, the researcher picked up the picture icon and said,

“It’s my turn.” During the following two minutes, matched-difficulty and tailored word

combinations were developed and were delivered in one of three conditions:

conversational speech, rhythm-based speech, and rhythm-based speech plus melody (see

Appendix E). Each animal in the barn toy was assigned a word combination delivered by

the researcher in a live presentation to the individual student. Each condition included

two sentences that were composed for two corresponding animals in the toy barn. During

51

each intervention, the researcher delivered the word combinations and encouraged the

child to repeat the sentences in the style of the current condition in order to facilitate

language skills. The interventionist spoke or sang the sentence twice, and encouraged the

child to repeat each sentence for one minute. The researcher repeated and prompted the

student to echo each sentence for one minute per sentence for a total of two minutes of

instruction. If the sentence was a rhythmic or melodic sentence, the researcher also

tapped the animal with the rhythm while the sentence was delivered.

Following two demonstrations of the sentence, the researcher gave the animal to

the student and asked him to repeat the sentence. If the student struggled with the

sentence, the researcher held the animal again and repeated the sentence. If the student

was unresponsive, the researcher took his hand to touch the animal, and repeated the

sentence again. If the student continued to be unresponsive, the researcher continued to

the other animal. During the intervention sequence, the data collectors recorded RRS

behaviors and language output.

Following the intervention, the researcher gave the picture icon back to the

student and said “It’s your turn,” and the student was given another two minute free-play

opportunity, where RRS and language skills were again be recorded in the same manner

as previously stated. The students were cued to end playtime, when the researcher sang

the familiar goodbye song to signal the conclusion of the regular specialized music class.

The student was escorted back to his classroom by the researcher.

Intervention Delivery Schedule

52

The delivery schedule was consistent across each condition and student. Each

participant was presented one condition on three separate days across a single week,

followed by three sessions for each of the other two conditions in subsequent weeks. The

protocol lasted for approximately eight minutes: one minute transition from the

classroom to music room, two minute free play (pre-test), two minute intervention, two

minute free play (post-test) and one minute transition from music room to classroom.

Each protocol session occurred with the researcher and a single participant. Interventions

occurred at the same time every day to provide consistency.

Interventionist

The researcher served as the sole interventionist. She currently holds a Bachelor

of Music Education with a minor in special education and is currently completing a

Masters of Music Education degree. The researcher has taught music for four complete

school years, all at the participating autism magnet school. In addition to general music

classes, she has offered specialized music instruction for all four years at the participating

school. Prior to her employment as a general music educator, she was employed as a

paraeducator in an autism program for 5 months. The researcher has daily interaction

with the children with autism, where each child attends a music class with typically

developing peers in addition to a specialized music class with activities geared toward

children with autism.

Treatment Fidelity

Due to the small sample size and the familiarity of the researcher and data

collectors to the participant, it may be difficult to protect the identity of the child.

53

However, each participant was assigned a letter based on his or her enrollment in the

study. The letter identifier, not the child’s name, was used on the data collection forms.

The list of participant names and associated letter identifier was stored in a locked closet

in the music room in order to protect the participant’s identity outside of the school

district. All data and the signed informed consent documents were stored in a locked file

cabinet in the principal investigator’s (faculty advisor) university office. If the study is

published in the future, no identifying information to the school or the child will be

indicated.

Setting

Participants were recruited from a specialized instructional program at a public

elementary school in a large metropolitan area, where the researcher taught. The school

receives federal funds through the Title I program due to the high population of students

that receive free or reduced lunch. The school has 468 students enrolled, including 43

students who receive special education services, and 17 students who are in the

specialized instructional program.

The interventions occurred in a classroom familiar to the students within the

school. The classroom was away from other students, with only the interventionist, data

recorders and child participant present. The classroom had a door that was closed in

order to reduce ambient noise and distractions from others in the building.

54

CHAPTER 4

RESULTS

This study examined the following research questions:

1. Does rhythm-based speech enhance sensory organization more effectively than

conversational speech for children with autism spectrum disorders?

2. Does rhythm-based speech plus melody enhance sensory organization more

effectively than conversational speech and rhythm alone?

3. Does rhythm-based speech enhance language production more effectively than

conversational speech for children with autism spectrum disorders?

4. Does rhythm-based speech plus melody enhance language production more

effectively than conversational speech and rhythm alone?

Participant Flow

Students were recruited from a specialized instructional program for autism at a

large suburban public elementary school. Participants were recruited from a convenience

sample (N = 5) of children aged five to nine with an educational diagnosis of Autism

Spectrum Disorder. Five participants enrolled for the study and four participants were

able to fully complete the study. One student could not complete 1 of the 9 sessions due

to an absence from school. Table 2 displays the grade level for each participant and the

spontaneous expressive language abilities in the areas of syntax and semantics compared

to developmental age level norms as assessed by the school’s speech language

pathologist.

55

Table 2

Participant Demographics

Participant Current Grade Syntax

Language Age Semantic

Language Age A 1 3 years 3 years B K 4 years 4 years C 1 5.5 years 6 years D K 5 years 4.5 years E 3 2 years 2.5 years

This small sample limited the statistical power, but the counterbalanced design alleviated

the statistical limitations of a convenience sample. This sample is also reflective of

current music education classrooms and may provide information in an area that is under

explored in the music education literature.

For these participants, obtaining assent for each child was accomplished through

observation of behaviors. During the music sessions, the researcher was attuned to any

behaviors that could indicate that the student no longer wished to participate (e.g. left the

music room, verbally or non-verbally indicated they no longer wish to participate,

screamed, or demonstrated physical resistance). Protocol for assent stated that if any of

these behaviors were exhibited, the current activity would be stopped, the child supported

to a calm state, and the activity would resume. If the child continued to be upset, the

child would be given an opportunity to stop the activity and continue at a later date. No

sessions were stopped due to the child demonstrating his desire to no longer participate

through behaviors. One child politely stated that he did not want to go to the music

56

room, but when the child’s teacher asked him to go with the researcher, the child said he

would like to go.

Data Analysis

This study considered multiple dependent variables (sensory organization and

language skill) across the three conditions. Therefore, a one-way MANOVA was

calculated examining the effect of conversational speech, rhythmic speech, and rhythmic

speech plus melody on the language skills and RRS behaviors of a child with autism.

The Wilkes’s lambda of .095 did not indicate significant differences, F (64, 122) = 0.96,

p > .05. Neither language skills nor RRS were significantly influenced by rhythmic

speech or rhythmic speech with melody (see Table 3).

Table 3

MANOVA Results

Effect Value F Hypothesis

df Error df Sig. Intercept Pillai's Trace 0.974 93.092a 8 20 0

Wilks' Lambda 0.026 93.092a 8 20 0 Hotelling's Trace

37.237 93.092a 8 20 0

Roy's Largest Root

37.237 93.092a 8 20 0

Group Pillai's Trace 1.749 0.944 64 216 0.597 Wilks' Lambda 0.095 0.959 64 121.848 0.566 Hotelling's Trace

3.356 0.957 64 146 0.571

Roy's Largest Root

1.4 4.726b 8 27 0.001

57

Ancillary descriptive analyses were conducted to evaluate any differences that

may indicate educational value. The post-intervention free-play data means in each

condition were compared to the assessment baseline free-play for each child to determine

changes in language skills and RSS behaviors across time and condition. Percent of

change, or the relative change in a variable, was calculated to indicate pre-post outcome

differences for Participants B, C, D, & E. Participant A was not added to the calculation,

as he did not finish the melodic condition. The formula ((post-test mean - pre-test

mean)/pre-test mean)*100) was calculated to indicate the ratio of change between the

pre-test and the post-test. In order for the rhythm or rhythm plus melody conditions to be

more effective than conversational speech alone, language score percent of change means

would increase, while RRS behaviors would decrease. Percent of change means for each

condition are documented in Table 4 and graphically illustrated in Figure 1. Based on the

absence of significant change, no further data analysis was conducted.

58

Table 4

Percent of Change Means with Raw Data from Pre-Intervention to Post-Intervention

Participant Speech Pre-Test

Speech Post-test

Rhythm Pre-Test

Rhythm Post-test

Melody Pre-test

Melody Post-test

B 68 58 71 82 66 62 C 74 66 58 47 62 57 D 71 64 32 39 73 66 E 69 79 71 68 91 61

Language Percent of Change

-5.32% 1.72% -15.75%

Participant Speech Pre-Test

Speech Post-test

Rhythm Pre-Test

Rhythm Post-test

Melody Pre-test

Melody Post-test

B 20 31 24 26 0 4 C 3 1 1 4 7 9 D 0 2 0 1 0 0 E 43 81 53 99 66 92

RRS Behavior Percent of Change

74.24% 66.66% 43.84%

Note. Language scores are the sum of all observed language behaviors (vocalizations, gestures, single word utterances and multiple word utterances) of the pre-test or post-test in each condition. RRS behaviors scores are the sum of all observed RRS behaviors (unrelated vocal noises and inappropriate head, hand, and body movements) of the pre-test or post-test in each condition. See Appendix F for raw data.

59

-30.00%

-20.00%

-10.00%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Speech Rhythm Melody

Language

RRS

Figure 1. Percent of Change Means for Pre & Post Free Play. For rhythm or rhythm plus melody to be more effective than conversational speech alone, language scores would be shown to increase while RRS behaviors would be shown to decrease.

Language production frequency showed a slight positive increase from pre to post

intervention free play in rhythmic speech condition. The frequency of language

production decreased in the other conditions with a more marked decrease following the

rhythmic speech plus melody conditions. RSS behaviors decreased the most in the

melodic condition.

In addition, means of language output and RSS behaviors were calculated during

intervention times across conditions. Behaviors during instruction were measured so

findings might inform a classroom setting. The sum of language and RSS behaviors were

calculated for each participant; Participant A was included in this calculation even though

he not complete all three sessions in of the rhythmic speech plus melody condition due to

60

illness. This calculation compared number of sessions completed opposed to means

across all sessions, so Participant A was included despite not finishing the final session.

The sum of the language scores of all participants was divided by the number of sessions

completed by all participants in for each condition. The sums of the RSS scores of all

participants were also divided by the number of sessions completed by all participants for

each condition. The following formulas were used for the speech and rhythmic speech

conditions ((total language scores/15 sessions) and (total RSS scores/15 sessions)) and

the following formulas for melody conditions, to account for the final session not

completed for Participant A in the melody condition ((total language scores/14 sessions)

and (total RSS scores/14 sessions)). Table 5 shows the raw data for intervention sessions

and the mean scores from the intervention.

61

Table 5

Mean Scores of Language and RSS Behaviors During Intervention

Participant Speech -Language

Rhythm - Language

Melody - Language

Speech - RRS

Rhythm - RRS

Melody - RRS

A 57 41 35 12 7 8 B 36 69 51 16 8 4 C 56 46 47 1 2 0 D 55 40 40 0 1 0 E 59 84 65 57 53 68

Sum 263 280 238 86 71 80 Mean 17.53 18.67 17.00 5.73 4.73 5.71

Note. Language scores are the sum of all observed language behaviors (vocalizations, gestures, single word utterances and multiple word utterances) of the intervention in each condition. RRS behaviors scores are the sum of all observed RRS behaviors (unrelated vocal noises and inappropriate head, hand, and body movements) of the intervention in each condition. See Appendix F for raw data.

0

2

4

6

8

10

12

14

16

18

20

Speech Rhythm Melody

Language

RRS

Figure 2. Mean scores of language and RSS behaviors during intervention. For rhythm or rhythm plus melody to be determined as more effective than conversational speech alone, language skills would increase while RRS behaviors would decrease.

62

While there was little difference between intervention score means across the

three conditions, language scores for rhythmic speech were slightly higher during

intervention than other conditions, and RSS behaviors were slightly lower in rhythmic

speech compared to the other two conditions.

Observational Data

Since this was a small convenience sample, the researcher documented

observational data of each participant and session to supplement the observational data

taken during the session. The observational data is reported below.

Participant A (condition order: speech, rhythm, melody)

In the conversational speech condition, the student repeated both sentences during

intervention and when prompted during free play in all three sessions.

In the rhythmic condition, the given sentences were repeated during intervention

and when prompted in post-test free play, but he did not have the strong rhythmic

emphasis in the first session. In the second condition, more rhythmic emphasis was used.

In the third session, the rhythmic sentences were used and conversational sentences were

also used in the pre-test and post-test free play.

In the first melodic condition, during the free play, the student made up songs for

all the animals using the sentences from the previous conditions. When singing the hen

sentence, the participant moved the hen back and forth in the rhythm of the song. In the

second pre-test free play, the sentences were repeated in conversational speech for all

animals. Following the intervention in the post-test free play, the participant again used

his songs for each animal. The participant was unable to complete the third session due to

63

absence.

Participant B (condition order: melody, speech, rhythm)

In the melodic speech intervention, the participant responded and repeated the

sung sentences when prompted. In the second session post-test free play, the participant

used the given sentence about the hen, but not the sheep.

In the first conversational speech condition, during the intervention, the researcher

presented the spoken sentences through conversational speech. The participant repeated

the sentences back using the melody of the sheep melodic sentence. During second

conversational speech session, the participant again repeated the sentences back using a

melody. In the post-test free play, the participant made up new melodic sentences for all

animals, including animals that had not been presented in intervention previously.

In the rhythmic speech condition, the student was very verbal, but conversational

speech was not related to the situation. In the post-test free play, the student made up his

own stories about the animal and infrequently used the given sentences when prompted.

In the third session, the student filled in the all the sentences from each condition. The

sheep and pig sentences, which were in 6/8 time, were repeated more rhythmic accurate

than the 3/4 time sentences.

Participant C (condition order: speech, melody, rhythm)

Participant C struggled to remember the words of the rhythmic intervention

sentences. Conversational speech was better received and more easily remembered than

the melodic or rhythmic sentences. No other significant observational data was collected.

Participant D (condition order: rhythm, speech, melody)

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In all sessions, Participant D was very quiet. Prompting and questions from the

researcher were required for the participant to speak. There was little spontaneous speech

from the participant. At the end of all sessions, the participant could speak all the

intervention sentences. No condition was more effective in producing speech than

another.

Participant E (condition order: speech, melody, rhythm)

Participant E displayed more pronounced impairments in the categories of

language development and sensory functioning. In the conversational speech condition,

the participant displayed little response to the intervention. During the intervention and

after the intervention in all speech sessions, no sentences were repeated.

In the first melodic condition, the participant oriented toward the researcher when

she began to sing during the intervention session. However, the participant did not repeat

any of the sentences. During the post-test period of the second melodic condition, the

researcher prompted the sentence for the sheep by singing, “the sheep”, and the

participant filled in the remainder of the sentence of “lives on the farm.” The participant

did not respond to the prompts for the hen sentence. In the third melodic condition, when

prompted with the sung words, “the sheep”, the participant again finished the sentence of

“lives on the farm.” The participant also filled in the word “house” when prompted with

the hen sentence.

In the rhythmic condition, the participant responded minimally to the intervention

sentences. During the last rhythmic session, the participant would fill in the words

“farm” and “mud” for the sentence for the pig.

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CHAPTER 5

DISCUSSION

The following research questions were asked:

1. Does rhythm-based speech enhance sensory organization more effectively than

conversational speech for children with autism spectrum disorders?

2. Does rhythm-based speech plus melody enhance sensory organization more

effectively than conversational speech and rhythm alone?

3. Does rhythm-based speech enhance language production more effectively than

conversational speech for children with autism spectrum disorders?

4. Does rhythm-based speech plus melody enhance language production more

effectively than conversational speech and rhythm alone?

Results indicated that rhythmic-based speech and rhythm-based speech plus melody did

not enhance sensory organization or language production more effectively than

conversational speech and rhythm alone. While the statistical data showed no

significance, the researcher’s observational data recorded after each session with each

student merits consideration as a guide for future research.

The melody condition sparked interesting behaviors from three of the participants.

After receiving the melodic intervention, both Participants A and B used the melodic

inflections of the sentences in the intervention to create melodic sentences about other

animals. When Participant B was given the speech condition (after the receiving the

melodic condition the week before), the researcher stated the sentence in a spoken voice

and the participant echoed the sentence back, but with melodic inflection similar to the

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melody for the sheep (see Appendix E). Immediately following the speech intervention,

he made up melodic sentences for all the other animals, even ones that had not been

previously presented in an intervention. This occurred at the post-test period during the

first two conversational speech sessions. (See Appendix E for condition specific

sentences.) Participant A also created his own sentences after receiving the melodic

condition, which was his final condition to receive. Following the rhythmic speech plus

melody intervention, in the post intervention free-play the participant used the sentences

that had been given in the previous conditions, but added a melody to every sentence.

This happened in the two post-test melodic sessions the participant completed.

When these participants created original melodies, the melodies were sung in a

6/8 time signature, generally mimicking the melodic inflection of the sheep melody.

When repeating rhythms and melodies, the melodies and rhythms in 6/8 time signature

were repeated more accurately than those in 3/4 time signature. Many nursery rhymes

for young children are in the time signature of 6/8; perhaps a 6/8 meter is more readily

perceived for children with undeveloped language skills. Research is needed to explore

this phenomenon further.

Repetition of the sentences was often better for the melodic sentences than either

the speech or rhythmic sentences. Participant E, who had more severe language and

sensory organization impairments than the other participants, showed a marked accuracy

when repeating the melodic sentences than the other sentences. During spoken and

rhythmic interventions, this participant would not repeat the sentences. However, during

the melodic intervention, the participant would make eye contact with the researcher and

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would hold attention briefly. Participant E would never repeat any element of the spoken

condition sentences, and one word, “mud,” was repeated when prompted with parts of the

rhythmic sentences. Yet when the melody and words, “the sheep” was prompted, the

participant did complete the remainder of the sentence, “lives on the farm.”

Interesting elements of prosody, or the emphasis, pitch accenting, rhythm and

intonation of speech were also observed during the melodic repetitions of the sentences.

Research suggests that perception and production of prosody is impaired in individuals

with autism (McCann et al., 2007; Paul et al., 2005; Shriberg et al., 2001). After the

melodic intervention, some participants worked hard to produce the inflection the melody

gave, whether the participant was singing or speaking. Participant B would often lift his

chin to emphasize the leap between the notes of E for “the” and the higher C for “sheep.”

Participant C would start the sentence for the sheep, yet when he did not produce the

same inflection of the melody, he would stop and start again to produce something close

to the large leap between “the” and “sheep.”

Similarities and Differences Between Current Results and Extant Research

While there is little research in the field of autism and music to facilitate language

development and sensory organization, some of the observations from the data collection

sessions are supported by previous research. A growing body of research exists in the

field of music therapy to support using music as a tool to address the functional needs of

an individual with autism (Kaplan & Steele 2005; Wan, et al., 2010; Whipple, 2004).

While the music-based conditions may not have been more effective than other

conditions, the participants responded positively to the musical content. Only one

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participant initially expressed once that he would not like to go to the music room with

the researcher, but agreed to go when prompted by the classroom teacher. The other

participants always enthusiastically went along with the researcher to the music room.

Auditory perception is often a mystery in the brain of an individual with autism.

Behaviors displayed by the participants may be supported by previous research studies.

Boddaert et al. (2003) suggested that individuals with autism might passively listen to

speech, perceiving it as strange noise rather than functional language. Whitehouse and

Bishop (2008) also suggest that the process of encoding speech sounds may be impaired

due to a possible aversion to speech sounds, and that novel tones generally caught the

attention more effectively than speech sounds for children with autism. Dawson et al.

(1998) also suggested that for a child with autism, orientation toward a sound stimulus

such as a musical toy or rattle produced fewer orienting errors when compared to a

speech stimulus.

In the current study, anecdotal evidence suggests the melodic speech may have

more readily caught the attention and allowed participants to actively listen to language

delivered through melody. This was demonstrated by a frequent and sharp change of

focus when melodic intervention began. This was also evidenced by the ability of the

participants, especially Participant E, to more readily repeat the melodic sentences

correctly with fewer attempts than the other conditions. Perception of language is

essential in the development of language skills. Future studies may attempt to measure

perception of language through behaviors of eye contact, orientation, and reproduction of

69

language. In the present study, however, these positive outcomes were not supported

through behaviors that were statistically analyzed.

Interpretation of Results

While the results from the MANOVA did not show that rhythm or melody

supported language production or sensory organization in children with autism, the way

the melodic sentences were used by the participants and how the participants responded

to the act of singing suggest that melody may capture the focus of attention, memory or

engage auditory perception for children with autism.

Other approaches to the data were examined as well. The percent of change from

pre-test free play to post-test free play was examined across the participants. While there

were only slight differences in scores, RSS behaviors decreased slightly in the melodic

condition compared to the speech and rhythmic condition. Language scores changed the

most positively in rhythmic conditions with a slight increase of language production.

However, when looking at the language scores of Participant E, the percent of change in

language scores for this participant prompted further examination (Table 6).

Table 6

Raw Data and Language Percent of Change Scores of Participant E

Speech Pre-Test

Speech Post-test

Rhythm Pre-Test

Rhythm Post-test

Melody Pre-test

Melody Post-test

69 79 71 68 91 61 Percent of

change 14.50% -4.23% -33%

70

Participant E’s percent of change scores decreased from the speech to rhythm to melodic

conditions meaning he had fewer post-test vocalizations during the melodic condition.

While this is contrary to the hypothesis, the quality of speech must be examined.

Participant E had very low language skills and much of his language consisted of

vocalizations that were not functional. The data collection tool in this study did not

specify functional versus non-functional vocalizations, but merely documented

vocalization events. Nevertheless, closer examination of the percent of change

characteristics in vocalizations during the conditions is worth noting (Table 7).

Table 7

Raw Data and Percent of Change in Participant E's Vocalization Scores

Speech Pre-Test

Speech Post-test

Rhythm Pre-Test

Rhythm Post-test

Melody Pre-test

Melody Post-test

35 40 30 37 47 37 Percent of

change 14.29% 23.33% -21.80%

Participant E had a steep drop in frequency of vocalizations after the melodic conditions.

It may be that the melodic condition was able to organize his language better, displayed

by a drop in inappropriate language. Subsequent studies must measure not only language

production, but be sensitive to appropriate language production opposed to vocal noises

or inappropriate language for the situation. Response definitions for data collection must

reflect these sensitive differentiations in language production.

The means of the intervention scores were also calculated. There was little

difference between intervention score means in the three conditions, but language scores

71

for rhythmic speech were slightly higher during this intervention than the other

conditions, and RSS behaviors were slightly lower in rhythmic speech compared to the

other two conditions. This may indicate that when a researcher is presenting content,

rhythmic speech is slightly more effective in producing language and calming the sensory

system. While behavioral observations recorded a difference in perception and focus of

attention, presenting speech rhythmically could have slightly more efficacy to calm the

sensory system and produce slightly more language than other conditions.

This study had some limitations that are important to consider when discussing

future studies of this nature. The sample size was small at only five participants, and

only four were able to complete all nine sessions. When conducting the study,

permission to video record sessions was denied. Participant E in particular had numerous

and wide ranging language vocalizations and sensory behaviors, making it hard for data

collectors to accurately record his fast paced vocalizations. This could have led to

imprecision in recording. If video recording had been allowed, data could have been

more sensitively measured with greater reliability.

A few limitations also existed in the data collection method. Language

production measures should have taken into account how language was being used.

Other elements to measure could have been how the language was being used (was it

appropriate or inappropriate to the situation), whether the sentences were from the

interventions being used in the free-play session, and how the language was produced

(conversationally spoken, rhythmically spoken, sung). In addition,the data collection did

not account for the different profiles of sensory dysfunction. Research suggests sensory

72

dysfunction can be demonstrated through three profiles: under-stimulation to sensory

input, over-stimulation to sensory input and sensory seeking behaviors (Ben-Sasson et al.,

2009; Chen et al., 2009; Dunn, 2006) Therefore, sensory-seeking RSS behaviors such as

such as inappropriate hand, head and body movements cannot solely demonstrate an

individual’s sensory dysfunction. Participants A and E demonstrated behaviors that

could be characterized into the sensory-seeking profile of sensory dysfunction. In

contrast, Participants C and D demonstrated an under-stimulated sensory profile.

Unfortunately, data collection only recorded frequency of sensory-seeking behaviors.

This would explain why Participants C and D displayed very few sensory behaviors

across all sessions. More sensitive measurement tools would alleviate such discrepancies

in future studies.

Other elements with timing of the sessions should be taken into consideration for

future studies. The first consideration is the intervention time. It may be that two

minutes is too short a time to organize sensory systems. It may be beneficial to consider

other speech, rhythmic or melodic activities that could expand the intervention time to

give the student more time to organize his or her systems. This could include playing the

rhythms or melodies on an instrument, or expanding the sentences to include stories for

the participant to listen to about the animals presented in a rhythmic or melodic manner.

Also, imaginative play skills were very low for some of the participants. This caused the

free-play time to be too long for participants C and D, as these participants did not always

know how to play with the animals. New questions and prompts then needed to be

composed on the spot for those children, which could have affected the language scores.

73

Generalizability of Findings

According to the statistical results of this study, there is no evidence to suggest

that rhythmic speech or melody is more effective at producing language skills or

organizing sensory systems for individuals with autism. However, none of these

strategies were ineffective at producing language. It may be that the one to one ratio of

teacher to student and intentionally addressing the language skills of the individual was

effective, despite the medium.

An examination of behavioral data might give insight to music educators and the

treatment of individuals with autism within the music classroom. Further research is

needed, but if in fact melody does help with auditory perception of and orientation

toward language, music educators should be made aware that the music classroom could

be a place where an individual with autism perceives and focuses on the language that is

sung. Music educators may have an opportunity to use high quality texts in classes of

students with autism. The language need not be complicated, but use of cultural folk

music, poetry set to music, and literature set to music could be used.

The Orff-Schulwerk approach of teaching music is highly based upon using

rhythm and melody to incorporate language in the rhythmic playing of instruments,

spoken ostinati, and singing (Frazee & Kreuter, 1987). This approach to music education

is designed around the marriage of rhythm and language. The Orff-Schulwerk could be a

readily available way for music educators to link rhythm and language for students with

autism in order to facilitate auditory perception of language. It is also an approach to

teaching music that is widely used in the music classroom that could facilitate the

74

integration of music standards for typically developing children with the specialized

needs of children with autism.

Discussion of Implications for Future Research

Many suggestions for future research have been discussed. Yet, the largest

considerations emerging from this project for future research lie in the areas of auditory

perception and prosody. Future projects that replicate elements of this study should focus

on how auditory perception might be measured, whether that is in the areas of orienting

or repetition of sentences. It may be that melody enhances auditory perception, which

could improve language skills over time. The element of prosody could also be affected

by melodic presentation of language. Multiple participants noticed and responded to the

direction of the melodic line in the melodic presentations, and tried to replicate this

contour. Participants B and C, who were observed to replicate the melodic line, generally

demonstrate poor prosody in their conversational language skills. There is some

evidence that perception of speech intonation and melodic contour may share cognitive

resources (Patel et al., 1998). Using melodies that are developed from prosodic patterns

in speech might in turn help develop prosody over time for individuals with autism.

While the statistical tests did not produce any significant results to answer the

research questions, there is still a strong theoretical basis for continuing research in the

area of sensory organization and language through rhythm and melody. The lack of

statistical outcomes may have been due to the limitations of the data collection method.

It still may be that rhythm and melody can be an avenue to facilitate sensory organization

through the organization and temporal sense of music. There are still many findings in

75

behavioral studies and in neurological research in the areas of language and music to

suggest why music might be effective for addressing language development and sensory

organization. It is important that music educators continue to seek out ways to not only

teach all children music, but also to use music teaching as a way to enhance the learning

across all domains for children, and if indeed it is effective in language and sensory

development, especially for children with autism.

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APPENDIX A

UMKC SSIRB APPROVAL LETTER

77

From: Barreth, Rebekah Sent: Thursday, December 22, 2011 12:09 PM To: Hanson-Abromeit, Deanna Cc: Lillie, Sarah M. (UMKC-Student) Subject: RE: Study SS11-171X: The Effect of Rhythm and Melody on Language Development and Sensory Organization in Children with Autism Dear Investigators, Please find attached the ICF for your use. Please be sure to use this document for consenting parents. You should know that even the chair commented on how well thought out and well written this application was. The responses were appropriately justified and clear and only minor edits were requested at the time of screening. Well done, and thank you for a nice application to review! Regards, Rebekah Barreth, CIP Compliance Officer Research Compliance Office 5319 Rockhill rd, Kansas City, MO 64110 816-235-6150 [email protected]<mailto:[email protected]>

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APPENDIX B

REQUEST FOR PARTICIPATION

IN A RESEARCH STUDY

79

Request for Participation in a Research Study

The Effect of Rhythm and Melody on Language Development and Sensory Organization in Children with Autism

Sarah Lillie

Sunny Pointe Elementary School and University of Missouri-Kansas City

Deanna Hanson-Abromeit University of Missouri-Kansas City

Dear Parents, My name is Sarah Lillie. I am the music teacher at Sunny Pointe Elementary and I am also a graduate student in the Division of Music Education and Music Therapy at the University of Missouri-Kansas City. I am inviting students from Sunny Pointe who are aged five to nine, receive special education services under the category of autism, and currently attend the autism music class with me to participate in this research study. I am hoping to recruit one to five children from our school to participate in this study to learn how rhythm and singing can help speech and sensory organization for a child with autism. This study is being supervised by Deanna Hanson-Abromeit, the principal investigator of this study and an associate professor of music therapy at UMKC. I am hoping to observe a child’s speech and sensory organization behaviors are effected by presenting sentences in one of three ways: spoken sentences, rhythm-based sentences and sung sentences. The child will spend time with me repeating sentences and free playing with plastic toy farm animals. Participation in this study is voluntary. If you agree for your child to be part of this study, your child and I will meet in the music classroom at Sunny Point Elementary during a sensory break 3 times a week for 3 weeks for a total of 9 sessions. Each one to one meeting will be during the school day at a regularly scheduled sensory break. I would love to set up a time to meet with you to discuss this study further. I will be calling you in the next two days to find if you are interested and would like more information. If you have any questions about this study please contact: Sarah Lillie, Music Teacher at Sunny Point Elementary and investigator 816-224-7800, email: [email protected] or Deanna Hanson-Abromeit, Associate Professor of Music Therapy, University of Missouri-Kansas City, faculty adviser and principal investigator 816-235-2906, email: [email protected] Sincerely, Sarah Lillie Deanna Hanson-Abromeit

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APPENDIX C

CONSENT FOR PARTICIPATION

IN A RESEARCH STUDY

81

Consent for Participation in a Research Study

The Effect of Rhythm and Melody on Language Development and Sensory Organization in Children with Autism

Sarah Lillie

Sunny Pointe Elementary School and University of Missouri-Kansas City

Deanna Hanson-Abromeit University of Missouri-Kansas City

Dear Parents, My name is Sarah Lillie. I am the music teacher at Sunny Pointe Elementary and I am also a graduate student in the Division of Music Education and Music Therapy at the University of Missouri-Kansas City. I am inviting students from Sunny Pointe who are aged five to nine, receive special education services under the category of autism, and currently attend the autism music class with me to participate in this research study. I am hoping to recruit one to five children from our school to participate in this study to learn how rhythm and singing can help speech and sensory organization for a child with autism. This study is being supervised by Deanna Hanson-Abromeit, the principal investigator of this study and an associate professor of music therapy at UMKC. Participation in this study is voluntary. If you agree for your child to be part of this study, your child and I will meet in the music classroom at Sunny Point Elementary during a sensory break 3 times a week for 3 weeks for a total of 9 sessions. Each one to one meeting will be during the school day at a regularly scheduled sensory break. Each session will last eight minutes, including time to travel to and from the classroom. Using plastic toy farm animals, I will allow your child to play with the farm for 2 minutes. Following this free play time, your child and I will play with the animal in one of three ways: spoken sentences, rhythm-based sentences and sung sentences. We will play with the toy in one way three times over the course of one week, followed by the other two ways in following weeks. Not every child will receive the sentences in the same order. After your child and I have played using the sentences for two minutes, your child with have an additional two minutes of free play using a Fisher-Price animal farm. During each session we will count your child’s use of spoken language and sensory behaviors to see if there are changes when I use spoken sentences, rhythm-based sentences and sung sentences with your child. Travel time is given one minute both in traveling to and from the music classroom. The total amount of time your child will spend in the individual sessions with me across 3 weeks is 72 minutes.

SS11-171X

82

SS11-171X

All of the information I obtain from your child will be kept confidential. Your child’s name will not be used on any of the forms for data collection, and no information about your child will ever leave school premises with a name attached. If the study were to be published, no identifying information to the school will be provided. While every effort will be made to keep confidential all of the information you complete and share, it cannot be absolutely guaranteed. Individuals from the University of Missouri-Kansas City Institutional Review Board (a committee that reviews and approves research studies), Research Protections Program, and Federal regulatory agencies may look at records related to this study for quality improvement and regulatory functions. Mr. Goos, Sunny Pointe Elementary Principal and Dr. Brouse, Blue Springs Director of Elementary Education, have approved this study. However, participation in this study is voluntary at all times. You may choose to not participate or to withdraw your participation at any time. Deciding not to participate or choosing to leave the study will not result in any penalty or loss of benefits to which you are entitled. Your decision to not participate will not affect your relationship with UMKC, Blue Springs School District, or the researcher now or in the future. If you decide to leave the study the information you have already provided will be shredded. There is no cost to you for allowing your child to participate in this study. You will not receive any compensation for participating in this study. While there are no direct benefits to you or your child for participating in this study, your child will receive more individual language instruction across the three weeks. The information from this study may help us learn more about what helps language development and sensory organization for children with autism. The only known risk associated with the study is a small change in routine by adding three weekly music sensory breaks to their weekly schedule. The time the child leaves the classroom has been coordinated with your child’s teacher so that it will take place during a sensory break your child currently receives during the instructional day. Careful consideration will be given to the change of schedule, and behaviors will be watched that might indicate the child is upset by the change in schedule. During the music sessions, the researcher will be watching for any behaviors that could indicate that your child no longer wishes to participate (leaves the music room, verbally or non-verbally indicated they no longer wish to participate, screaming, physical resistance, etc.). If any of these behaviors are exhibited, the current activity will be stopped, the child will be supported to a calm state and the activity will be resumed. If the child continues to be upset, the child will be given an opportunity to continue at a later date.

83

SS11-171X

The University of Missouri-Kansas City appreciates the participation of people who help it carry out its function of developing knowledge through research. If you have any questions about the study that your child is participating in you are encouraged to call Sarah Lillie, the investigator, at 816-224-7800 or Deanna Hanson-Abromeit, the faculty adviser, at 816-235-2906. Although it is not the University’s policy to compensate or provide medical treatment for persons who participate in studies, if you think you have been injured as a result of participating in this study, please call the IRB Administrator of UMKC’s Social Sciences Institutional Review Board at 816-235-1764. If you have any questions about this study please contact: Sarah Lillie, Music Teacher at Sunny Point Elementary and investigator 816-224-7800, email: [email protected] or Deanna Hanson-Abromeit, Associate Professor of Music Therapy, University of Missouri-Kansas City, faculty adviser and principal investigator 816-235-2906, email: [email protected] If you agree that your child may take part in the research please return a signed copy of this form to me in the enclosed envelope. You may keep the other copy for future reference. You have read this permission form and agree to have your child take part in the research. _________________________________________ Name of Student __________________________________________ Printed Name of Parent ___________________________________________ _________________ Signature of Parent Date ___________________________________________ _________________ Signature of Investigator Date ___________________________________________ _________________ Signature of Faculty Adviser/Principal Investigator Date

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APPENDIX D

DATA COLLECTION TOOL

85

Data Collection Tool Intervention content: Conversational Speech Rhythmic Speech Rhythm + Melody

Pre-test

Free Play Session (2 minute free play)

Gestures Vocalizations Single Word

Utterance Multiple Word

Utterance

Intervention

Intervention (1 minute on each sentence, 2 sentences presented)

Gestures Vocalizations Single Word

Utterance Multiple Word

Utterance

Post-test

Free Play Session (2 minute free play)

Gestures Vocalizations Single Word

Utterance Multiple Word

Utterance

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Data Collection Tool Intervention content: Conversational Speech Rhythmic Speech Rhythm + Melody

Pre-test

Free Play Session (2 minute free play)

Hand Head Body Unrelated Vocal

Intervention

Intervention (1 minute on each sentence, 2 sentences presented)

Hand Head Body Unrelated Vocal

Post-test

Free Play Session (2 minute free play)

Hand Head Body Unrelated Vocal

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APPENDIX E

MATCHED-SENTENCES AND

MUSICAL EXAMPLES

88

Word Count

Words per

sentence

Avg Letters / word

Reading Ease Score

Conversational Speech

Goat The goat lives on the farm. The goat likes to jump and play! Maaa, maaa!

14 7 3.6 100

Cow The cow lives on the farm. The cow eats all the grass. Moo, Moo!

13 6.5 3.4 100

Rhythmic Speech

Pig The pig lives on the farm. The pig likes to roll in the mud! Oink, Oink!

15 7.5 3.2 100

Horse The horse lives on the farm. The horse runs fast by the barn. Neigh! Neigh!

14 7 3.7 100

Melody + Rhythm

Sheep The sheep lives on the farm. The sheep likes to cut her wool. Baa Baa Baa!

13 6.5 3.6 100

Hen The hen lives on the farm. The hen lays eggs in her house. Cluck, cluck, cluck!

13 6.5 3.4 100

1. The goat lives on the farm. The goat likes to jump and play!

2. The cow lives on the farm. The cow eats all the grass.

3. The pig lives on the farm. The pig likes to roll in the mud!

4. The horse lives on the farm. The horse runs fast by the barn.

5. The sheep lives on the farm. The sheep likes to cut her wool.

6. The hen lives on the farm. The hen lays eggs in her house.

Nouns Articles (the, a, an) Prepositions Present-tense verbs (runs, eats, lives...verb + /s/) Infinitive verb (“to” plus verb...to cut, to roll) Possessive pronouns (her, his, their) Adverb Conjunction (and) Transitive verb (likes) Adjectives (all)

89

Rhythmic speech sentences:

Rhythm and melody sentences:

90

APPENDIX F

RAW DATA

91

Part. & Gestures Vocal SWU MWU TOTAL Hand Head Body URV TOTAL RRS Session LANG

SpeechPreA1 3 0 4 11 0 0 1 0 SpeechPreA2 0 3 4 15 0 0 0 2 SpeechPreA3 0 1 1 18 0 0 0 0

SpeechPreA 3 4 9 44 60 0 0 1 2 3 SpechIntA1 0 1 6 19 0 0 2 1 SpechIntA2 0 1 4 13 0 0 2 0 SpechIntA3 0 0 1 12 0 0 6 1

SpeechIntA 0 2 11 44 57 0 0 10 2 12 SpeechPostA1 2 1 2 22 0 1 3 1 SpeechPostA2 1 0 4 11 0 0 0 0 SpeechPostA3 0 2 8 11 0 0 1 1

SpeechPostA 3 3 14 44 64 0 1 4 2 7 RhythmPreA4 0 1 6 17 0 0 0 4 RhythmPreA5 0 2 4 23 0 0 2 0 RhythmPreA6 0 1 0 9 0 0 1 5 RhythmPreA 0 4 10 49 63 0 0 3 9 12 RhythmIntA4 0 1 3 18 0 1 3 0 RhythmIntA5 0 0 0 14 0 0 1 0 RhythmIntA6 0 0 0 5 0 0 1 1 RhythmIntA 0 1 3 37 41 0 1 5 1 7 RhythmPostA4 0 2 1 12 0 0 3 2 RhythmPostA5 0 0 6 17 0 0 2 1 RhythmPostA6 0 0 0 10 0 0 5 2 RhythmPostA 0 2 7 39 48 0 0 10 5 15 MelodyPreA7 0 0 1 20 1 0 0 1 MelodyPreA8 0 0 3 16 0 0 1 0 MelodyPreA9 MelodyPreA 0 0 4 36 40 1 0 1 1 3 MelodyIntA7 0 0 1 15 0 0 0 0 0 MelodyIntA8 0 1 2 16 0 0 0 0 0 MelodyIntA9 MelodyIntA 0 1 3 31 35 0 0 0 0 0 MelodyPostA7 0 0 1 22 0 0 2 0 0 MelodyPostA8 0 0 3 20 0 0 0 0 0 MelodyPostA9 MelodyPostA 0 0 4 42 46 0 0 2 0 0

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Part. & Gestures Vocal SWU MWU TOTAL Hand Head Body URV TOTAL RRS Session LANG

SpeechPreB1 0 0 0 25 0 0 1 5 SpeechPreB2 0 0 0 29 0 0 3 2 SpeechPreB3 0 2 0 12 0 0 0 9 SpeechPreB 0 2 0 66 68 0 0 4 16 20 SpechIntB1 0 0 1 13 0 0 5 2 SpechIntB2 0 0 0 17 0 2 1 0 SpechIntB3 0 0 0 5 0 0 4 2 SpeechIntB 0 0 1 35 36 0 2 10 4 16 SpeechPostB1 0 0 0 21 0 0 0 4 SpeechPostB2 0 1 5 18 0 0 0 13 SpeechPostB3 0 2 3 8 1 0 3 10 SpeechPostB 0 3 8 47 58 1 0 3 27 31 RhythmPreB4 0 0 2 21 0 0 0 4 RhythmPreB5 0 0 3 20 0 0 0 7 RhythmPreB6 0 0 1 24 0 0 0 13 RhythmPreB 0 0 6 65 71 0 0 0 24 24 RhythmIntB4 0 0 1 18 0 0 0 1 RhythmIntB5 0 1 0 27 0 0 1 1 RhythmIntB6 0 0 1 21 0 0 4 1 RhythmIntB 0 1 2 66 69 0 0 5 3 8 RhythmPostB4 0 1 2 29 0 0 0 5 RhythmPostB5 0 1 1 21 0 0 0 10 RhythmPostB6 0 0 2 25 0 0 2 9 RhythmPostB 0 2 5 75 82 0 0 2 24 26 MelodyPreB7 0 0 6 15 0 0 0 0 MelodyPreB8 0 0 6 15 0 0 0 0 MelodyPreB9 0 0 1 23 0 0 0 0 MelodyPreB 0 0 13 53 66 0 0 0 0 0 MelodyIntB7 0 1 0 13 0 0 0 0 MelodyIntB8 0 0 2 15 0 0 1 0 MelodyIntB9 0 0 0 20 0 0 1 2 MelodyIntB 0 1 2 48 51 0 0 2 2 4 MelodyPostB7 0 0 2 18 0 0 0 0 MelodyPostB8 0 1 2 18 0 0 1 2 MelodyPostB9 0 0 1 20 0 0 0 1 MelodyPostB 0 1 5 56 62 0 0 1 3 4

93

Part. & Gestures Vocal SWU MWU TOTAL Hand Head Body URV TOTAL RRS

Session SPEECH SpeechPreC1 0 1 5 16 0 0 0 3 SpeechPreC2 0 1 8 21 0 0 0 0 SpeechPreC3 0 0 7 15 0 0 0 0 SpeechPreC 0 2 20 52 74 0 0 0 3 3 SpechIntC1 0 1 4 10 0 0 0 0 SpechIntC2 0 0 3 16 0 0 1 0 SpechIntC3 0 0 8 14 0 0 0 0 SpeechIntC 0 1 15 40 56 0 0 1 0 1 SpeechPostC1 0 0 4 15 0 0 0 0 SpeechPostC2 0 0 15 12 0 0 0 1 SpeechPostC3 0 2 8 10 0 0 0 0 SpeechPostC 0 2 27 37 66 0 0 0 1 1 RhythmPreC4 0 0 1 18 0 0 0 1 RhythmPreC5 0 0 1 14 0 0 0 0 RhythmPreC6 4 0 2 18 0 0 0 0 RhythmPreC 4 0 4 50 58 0 0 0 1 1 RhythmIntC4 0 0 1 13 0 0 0 0 RhythmIntC5 0 0 1 11 1 0 0 0 RhythmIntC6 0 0 4 16 0 0 1 0 RhythmIntC 0 0 6 40 46 1 0 1 0 2 RhythmPostC4 0 0 3 10 0 0 0 0 RhythmPostC5 0 0 2 13 0 0 0 0 RhythmPostC6 0 0 2 17 0 0 3 1 RhythmPostC 0 0 7 40 47 0 0 3 1 4 MelodyPreC7 0 0 6 18 0 0 0 0 MelodyPreC8 0 0 4 18 0 0 0 0 MelodyPreC9 0 0 2 14 0 0 0 0 MelodyPreC 0 0 12 50 62 0 0 0 0 0 MelodyIntC7 0 0 2 13 0 0 0 0 MelodyIntC8 0 0 1 13 0 0 0 0 MelodyIntC9 0 0 6 12 0 0 0 0 MelodyIntC 0 0 9 38 47 0 0 0 0 0 MelodyPostC7 0 0 2 12 0 0 0 0 MelodyPostC8 0 0 6 14 0 0 0 1 MelodyPostC9 0 0 6 17 0 0 0 3 MelodyPostC 0 0 14 43 57 0 0 0 4 4

94

Part. & Gestures Vocal SWU MWU TOTAL Hand Head Body URV TOTAL

RRS Session SPEECH SpeechPreD1 0 0 12 5 0 0 0 0 SpeechPreD2 0 0 24 6 0 0 0 0 SpeechPreD3 0 0 15 9 0 0 0 0 SpeechPreD 0 0 51 20 71 0 0 0 0 0 SpechIntD1 0 0 2 17 0 0 0 0 SpechIntD2 0 0 1 14 0 0 0 0 SpechIntD3 3 0 6 12 0 0 0 0 SpeechIntD 3 0 9 43 55 0 0 0 0 0 SpeechPostD1 0 0 8 7 0 0 0 1 SpeechPostD2 0 0 16 10 0 0 0 1 SpeechPostD3 1 0 14 8 0 0 0 0 SpeechPostD 1 0 38 25 64 0 0 0 2 2 RhythmPreD4 0 0 6 8 0 0 0 0 RhythmPreD5 0 0 5 2 0 0 0 0 RhythmPreD6 1 0 4 6 0 0 0 0 RhythmPreD 1 0 15 16 32 0 0 0 0 0 RhythmIntD4 0 0 0 12 0 0 0 1 RhythmIntD5 0 0 2 13 0 0 0 0 RhythmIntD6 0 0 1 12 0 0 0 0 RhythmIntD 0 0 3 37 40 0 0 0 1 1 RhythmPostD4 0 0 2 10 0 0 0 1 RhythmPostD5 1 0 4 7 0 0 0 0 RhythmPostD6 0 0 3 12 0 0 0 0 RhythmPostD 1 0 9 29 39 0 0 0 1 1 MelodyPreD7 0 0 15 12 0 0 0 0 MelodyPreD8 0 0 9 8 0 0 0 0 MelodyPreD9 0 0 16 13 0 0 0 0 MelodyPreD 0 0 40 33 73 0 0 0 0 0 MelodyIntD7 0 0 2 14 0 0 0 0 MelodyIntD8 0 0 0 12 0 0 0 0 MelodyIntD9 0 0 0 12 0 0 0 0 MelodyIntD 0 0 2 38 40 0 0 0 0 0 MelodyPostD7 0 0 7 8 0 0 0 0 MelodyPostD8 0 0 13 12 0 0 0 0 MelodyPostD9 0 0 9 17 0 0 0 0 MelodyPostD 0 0 29 37 66 0 0 0 0 0

95

Part. & Gestures Vocal SWU MWU TOTAL Hand Head Body URV TOTAL

RRS Session SPEECH SpeechPreE1 0 10 6 1 0 0 0 8 SpeechPreE2 2 9 10 1 0 0 0 15 SpeechPreE3 3 16 10 1 0 0 3 17 SpeechPreE 5 35 26 3 69 0 0 3 40 43 SpechIntE1 2 9 2 4 0 0 2 7 SpechIntE2 0 7 5 1 3 0 3 22 SpechIntE3 4 13 9 3 2 0 5 13 SpeechIntE 6 29 16 8 59 5 0 10 42 57 SpeechPostE1 0 8 7 2 0 1 0 17 SpeechPostE2 8 11 12 0 3 1 5 16 SpeechPostE3 0 21 10 0 0 0 2 36 SpeechPostE 8 40 29 2 79 3 2 7 69 81 RhythmPreE4 1 10 11 1 0 0 0 18 RhythmPreE5 0 13 9 2 0 0 3 15 RhythmPreE6 0 7 8 9 0 0 2 15 RhythmPreE 1 30 28 12 71 0 0 5 48 53 RhythmIntE4 5 7 12 4 3 2 6 6 RhythmIntE5 3 3 14 10 5 0 0 9 RhythmIntE6 3 7 7 9 1 4 5 12 RhythmIntE 11 17 33 23 84 9 6 11 27 53 RhythmPostE4 1 11 4 3 0 0 1 34 RhythmPostE5 0 10 9 5 0 0 0 18 RhythmPostE6 1 16 5 3 2 0 1 43 RhythmPostE 2 37 18 11 68 2 0 2 95 99 MelodyPreE7 0 19 12 3 0 0 1 20 MelodyPreE8 3 17 12 2 2 0 2 20 MelodyPreE9 0 11 8 4 0 0 0 21 MelodyPreE 3 47 32 9 91 2 0 3 61 66 MelodyIntE7 2 11 7 0 3 0 5 15 MelodyIntE8 1 9 1 6 8 1 3 15 MelodyIntE9 2 10 10 6 1 0 4 13 MelodyIntE 5 30 18 12 65 12 1 12 43 68 MelodyPostE7 0 11 6 0 0 0 1 23 MelodyPostE8 3 14 5 3 4 2 4 31 MelodyPostE9 0 12 5 2 1 0 4 22 MelodyPostE 3 37 16 5 61 5 2 9 76 92

96

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VITA

Sarah M. Lillie completed her Bachelors of Music Education degree at the

University of Northern Colorado in December of 2007. Following her education, she

worked as a paraprofessional in Boulder, Colorado, in an autism classroom. She moved

to Kansas City, Missouri in the summer of 2008 where she taught elementary music at an

elementary autism magnet school for four years. She completed her Masters of Music

Education from the University of Missouri – Kansas City in May of 2012. She will

continue teaching in northern Colorado after the completion of her graduate degree.